Individual
RICHARD SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1525 FULLILOVE DR, BOSSIER CITY, LA 71112-3346
(318) 747-1111
(318) 317-3333
Mailing address
2000 FAIRFIELD AVENUE, SHREVEPORT, LA 71104
(318) 222-8511
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4146
LA
Other
Enumeration date
11/21/2018
Last updated
11/21/2018
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