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General NPI Number Information
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NPI Number | 1366151367
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Entity Type | Individual
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Provider Name | CHRISTIANNA LYNN SULLIVAN LCSW LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 351 WILLIAMS LN
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City | CHATHAM
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State | IL
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Zip | 62629-1044
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Country | US
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Telephone | 217-553-6678
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Fax |
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Provider Business Mailing Address
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Address Line | 1521 S GLENWOOD AVE
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City | SPRINGFIELD
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State | IL
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Zip | 62704-3608
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Country | US
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Telephone | 217-553-6678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180011835
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149020276
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License Number State | IL
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