Individual
TINA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APSW
Contact information
Practice address
3860 MONROE RD, DE PERE, WI 54115-8399
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
135534-121
WI
1041C0700X
Clinical Social Worker
135534-121
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100329015
—
WI
Enumeration date
06/11/2025
Last updated
07/10/2025
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