Individual
BREANNA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LAC
Contact information
Practice address
624 CONNELL PARK LN, BATON ROUGE, LA 70806-6534
(225) 300-4850
Mailing address
10390 JEFFERSON HWY APT 246, BATON ROUGE, LA 70809-7246
(225) 505-0792
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1620
LA
1041C0700X
Clinical Social Worker
Primary
12807
LA
Other
Enumeration date
11/21/2018
Last updated
11/21/2018
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