Individual
MR. ROBERT DENNIS SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
102 CARLANNA LAKE ROAD, KETCHIKAN, AK 99901
(907) 225-5576
(206) 299-4244
Mailing address
3183 JACKSON HEIGHTS ST, KETCHIKAN, AK 99901-5782
(907) 225-5576
(206) 299-4244
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
605
AK
Other
Enumeration date
02/23/2007
Last updated
07/08/2007
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