Individual
PENNY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
5915 ORCHARD ST W BLDG B, TACOMA, WA 98467-3824
(253) 473-7474
(253) 474-9724
Mailing address
PO BOX 946, ROY, WA 98580-0946
(253) 843-2811
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00001128
WA
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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