Individual
EDISON SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3909 HIGHWAY 282, VAN BUREN, AR 72956-8718
(479) 242-1003
(501) 510-5917
Mailing address
3909 HIGHWAY 282, VAN BUREN, AR 72956-8718
(479) 242-1003
(501) 510-5917
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P2411018
AR
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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