Individual
AMANDA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3132 JEFFERSON ST, SAN DIEGO, CA 92110-4421
(619) 683-3100
Mailing address
3132 JEFFERSON ST, SAN DIEGO, CA 92110-4421
(619) 683-3100
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IMF75726
CA
Other
Enumeration date
08/21/2014
Last updated
08/25/2014
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