Individual
KRISTINA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
88 HALF MILE RD, SOUTHPORT, CT 06890-3032
(704) 779-3503
Mailing address
88 HALF MILE RD, SOUTHPORT, CT 06890-3032
(203) 450-2391
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/10/2021
Last updated
09/20/2021
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