Individual
HENRY EARL SULLIVAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC 1
Contact information
Practice address
510 NW 4TH ST, GRANTS PASS, OR 97526-2078
(541) 474-5189
(541) 474-5172
Mailing address
510 NW 4TH ST, GRANTS PASS, OR 97526-2078
(541) 474-5189
(541) 474-5172
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12-03-48
OR
Other
Enumeration date
04/01/2016
Last updated
04/01/2016
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