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General NPI Number Information
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NPI Number | 1225510753
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Entity Type | Organization
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Legal Business Name | HANNAH SULLIVAN LLC
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 2828 KRAFT AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49512
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Country | US
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Telephone | 586-943-3292
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 CALVIN AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-3212
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Country | US
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Telephone | 586-943-3292
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. HANNAH CHRISTINE SULLIVAN
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Credential | LMSW, LMFT
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Telephone | 586-943-3292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801085815
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License Number State | MI
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