Individual
SUSAN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCS2861, LC3877,
Contact information
Practice address
1 DELTA DR, WESTBROOK, ME 04092-4745
(207) 856-7227
(207) 856-2112
Mailing address
1 DELTA DR, WESTBROOK, ME 04092-4745
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CCS2861, LC3877
ME
Other
Enumeration date
07/07/2011
Last updated
07/07/2011
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