Individual
MARALISSA A SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
PO BOX 9012, FORT WAYNE, IN 46899-9012
(260) 676-0074
Mailing address
PO BOX 9012, FORT WAYNE, IN 46899-9012
(260) 676-0074
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002971A
IN
Other
Enumeration date
11/06/2012
Last updated
04/21/2025
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