Individual
DEREK NICHOLAS SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
3966 ATLANTA HWY STE 375, MONTGOMERY, AL 36109-2919
(334) 414-3066
Mailing address
3240 HILLCREST LN, MONTGOMERY, AL 36109-3538
(334) 414-3066
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/20/2025
Last updated
01/20/2025
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