MEDICARE: DELICIA 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1841690161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELICIA SULLIVAN

Provider Business Mailing Address
First Line	:	5600 BOULDER HWY # 2583
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7202
Country	:	US
Telephone Number	:	702-689-5871
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 BOULDER HWY # 2583
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-7202
Country	:	US
Telephone Number	:	702-689-5871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	08/25/2014

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Directions to “ DELICIA SULLIVAN ” Practice Location

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