Provider Demographics
NPI:1053605766
Name:ALISON SULLIVAN LCSW, LLC
Entity type:Organization
Organization Name:ALISON SULLIVAN LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-907-0991
Mailing Address - Street 1:1011 PRINCESS ANNE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3835
Mailing Address - Country:US
Mailing Address - Phone:540-907-0991
Mailing Address - Fax:540-899-3711
Practice Address - Street 1:1011 PRINCESS ANNE ST
Practice Address - Street 2:SUITE B
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3835
Practice Address - Country:US
Practice Address - Phone:540-907-0991
Practice Address - Fax:540-899-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007615251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health