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NPI Code Detail

MEDICARE: DESTINEE SULLIVAN

MEDICARE: DESTINEE SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorMI

General Provider Information

NPI Number : 1144187766
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINEE SULLIVAN
Provider Business Mailing Address
First Line : 5279 SPOKANE ST
Second Line :
City : DETROIT
State : MI
Zip : 48204-3647
Country : US
Telephone Number : 313-263-0077
Fax Number :
Provider Business Practice Location Address
First Line : 19211 ANGLIN ST
Second Line :
City : DETROIT
State : MI
Zip : 48234-1460
Country : US
Telephone Number : 313-263-0077
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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Directions to “ DESTINEE SULLIVAN ” Practice Location

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