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NPI Code Detail

MEDICARE: DOLLY L SULLIVAN LICSW

MEDICARE: DOLLY L SULLIVAN LICSW
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
1104100000XSocial WorkerBP00943037WV

General Provider Information

NPI Number : 1467638882
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOLLY L SULLIVAN LICSW
Provider Business Mailing Address
First Line : 937 CHEAT RD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-5631
Country : US
Telephone Number : 304-288-3504
Fax Number : 304-777-4487
Provider Business Practice Location Address
First Line : 937 CHEAT RD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-5631
Country : US
Telephone Number : 304-288-3504
Fax Number : 304-777-4487
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2008
Last Update Date : 09/12/2024

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Directions to “ DOLLY L SULLIVAN LICSW” Practice Location

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