Individual
DALE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 PARK AVE, IRONTON, OH 45638-1525
(740) 550-4991
Mailing address
305 PARK AVE, IRONTON, OH 45638-1525
(740) 550-4991
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046
—
OH
Enumeration date
03/15/2022
Last updated
03/15/2022
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