Provider Information for 1366151367
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Ms. CHRISTIANNA LYNN SULLIVAN LCSW LCPC
Sex: Female
NPI: 1366151367
Last Updated: 2022-11-17
Certification Date: 2022-11-17
Certification Date: 2022-11-17
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1366151367 | ||||||||||||
| Enumeration Date | 2022-11-17 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1521 S GLENWOOD AVE SPRINGFIELD, IL 62704-3608 United States Phone: 217-553-6678 | Fax: | ||||||||||||
| Primary Practice Address | 351 WILLIAMS LN CHATHAM, IL 62629-1044 United States Phone: 217-553-6678 | Fax: | ||||||||||||
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