Individual
DEBORAH JEAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
1215 SE 7TH AVE, GRAND RAPIDS, MN 55744-4201
(218) 313-1338
Mailing address
1215 SE 7TH AVE, GRAND RAPIDS, MN 55744-4201
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302323
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1021875
PREFERRED ONE
MN
01
—
188856100
IMCARE
MN
01
—
8199PNO
BCBS
MN
01
—
84-10374
UBH/MEDICA
MN
Enumeration date
06/05/2008
Last updated
06/05/2008
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