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General NPI Number Information
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NPI Number | 1679609911
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Entity Type | Individual
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Provider Name | ROBERT DENNIS SULLIVAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 102 CARLANNA LAKE ROAD
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City | KETCHIKAN
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State | AK
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Zip | 99901
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Country | US
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Telephone | 907-225-5576
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Fax | 206-299-4244
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Provider Business Mailing Address
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Address Line | 3183 JACKSON HEIGHTS ST
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City | KETCHIKAN
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State | AK
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Zip | 99901-5782
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Country | US
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Telephone | 907-225-5576
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Fax | 206-299-4244
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 605
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License Number State | AK
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