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General NPI Number Information
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NPI Number | 1538338330
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Entity Type | Individual
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Provider Name | MARTHA ELAINE SULLIVAN LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 2801 THOMASVILLE ROAD
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City | TALLAHASSEE
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State | FL
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Zip | 32308
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Country | US
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Telephone | 305-389-5059
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Fax | 267-501-0714
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Provider Business Mailing Address
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Address Line | 1108 ALAMEDA DRIVE
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City | TALLAHASSEE
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State | FL
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Zip | 32317
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Country | US
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Telephone | 305-389-5059
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH8596
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License Number State | FL
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