Individual
DIAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
800 BROADWAY, SUITE 315, FORT WAYNE, IN 46802-2149
(260) 489-6030
(260) 489-5536
Mailing address
800 BROADWAY, SUITE 315, FORT WAYNE, IN 46802-2149
(260) 489-6030
(260) 489-5536
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
34001106A
IN
Other
Enumeration date
04/25/2006
Last updated
03/04/2016
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