Provider Information for 1558790501
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Mr. DAVID SULLIVAN LLPC, CADC
Sex: Male
NPI: 1558790501
Last Updated: 2013-11-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1558790501 | ||||||||||||
| Enumeration Date | 2013-11-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 6728 VINING RD GREENVILLE, MI 48838-9784 United States Phone: 616-225-8220 | Fax:616-225-8226 | ||||||||||||
| Primary Practice Address | 6728 VINING RD GREENVILLE, MI 48838-9784 United States Phone: 616-225-8220 | Fax:616-225-8226 | ||||||||||||
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