=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154288215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDALL CAITLIN SULLIVAN LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 LIBERTY ST SW
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20175-2715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-621-7121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 161 SWAN FIELD AVE
-----------------------------------------------------
City | RANSON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25438-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-721-7617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701015671
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------