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General NPI Number Information
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NPI Number | 1477710291
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Entity Type | Individual
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Provider Name | ANDREA KAYE SULLIVAN MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 16 MOULTON ST E
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City | DECATUR
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State | AL
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Zip | 35601-2310
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Country | US
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Telephone | 256-822-2375
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Fax |
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Provider Business Mailing Address
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Address Line | 251 JOHNSTON ST SE STE 100
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City | DECATUR
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State | AL
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Zip | 35601-2515
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Country | US
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Telephone | 256-822-2375
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Fax | 256-584-2330
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3066
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License Number State | AL
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