MEDICARE: DANIELLE D SULLIVAN LMFTA

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	106H00000X	Marriage & Family Therapist	2454	NC

General Provider Information

NPI Number	:	1851783286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE D SULLIVAN LMFTA

Provider Business Mailing Address
First Line	:	PO BOX 454
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-0454
Country	:	US
Telephone Number	:	910-319-8558
Fax Number	:	833-799-3166

Provider Business Practice Location Address
First Line	:	13500 NC HIGHWAY 50
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-7934
Country	:	US
Telephone Number	:	910-319-8558
Fax Number	:

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

Provider Enumeration Date	:	02/23/2015
Last Update Date	:	11/28/2022

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