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NPI Code Detail

MEDICARE: CHRISTINE KAREN SULLIVAN LMSW

MEDICARE: CHRISTINE KAREN SULLIVAN LMSW
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 Worker13539SC

General Provider Information

NPI Number : 1619634367
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE KAREN SULLIVAN LMSW
Provider Business Mailing Address
First Line : 852 GOLD HILL RD STE 204
Second Line :
City : FORT MILL
State : SC
Zip : 29708-6965
Country : US
Telephone Number : 585-683-2957
Fax Number :
Provider Business Practice Location Address
First Line : 852 GOLD HILL RD STE 204
Second Line :
City : FORT MILL
State : SC
Zip : 29708-6965
Country : US
Telephone Number : 803-228-4038
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2021
Last Update Date : 12/23/2021

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