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Individual
MS. JESSIE ELAINE SULLIVAN
Active
Individual
MS. JESSIE ELAINE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC,LMFT
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-119
ID
106H00000X
Marriage & Family Therapist
LMFT-2963
ID
Other
Enumeration date
06/25/2008
Last updated
06/16/2011
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