Individual
DR. GLENN R SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
30 CROSSING LN STE 101, LEXINGTON, VA 24450-6354
(540) 463-2080
(540) 464-7648
Mailing address
106 COLSTON PL, LEXINGTON, VA 24450-1812
(540) 463-2080
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003867
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103398805
UNITED HEALTHCARE
VA
01
—
336-841
ANTHEM
VA
01
—
923366841
HEALTHKEEPERS
VA
05
—
SC0001096
—
VA
Enumeration date
03/18/2008
Last updated
03/19/2018
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