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NPI Code Detail

MEDICARE: HEATHER SULLIVAN

MEDICARE: HEATHER 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
1101YM0800XMental Health Counselor12110NC

General Provider Information

NPI Number : 1750042313
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER SULLIVAN
Provider Business Mailing Address
First Line : 400 N CHURCH ST
Second Line :
City : MONROE
State : NC
Zip : 28112-4804
Country : US
Telephone Number : 980-552-1023
Fax Number :
Provider Business Practice Location Address
First Line : 400 N CHURCH ST
Second Line :
City : MONROE
State : NC
Zip : 28112-4804
Country : US
Telephone Number : 704-296-9898
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2022
Last Update Date : 09/11/2024

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Directions to “ HEATHER SULLIVAN ” Practice Location

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