Individual
ALEXANDER BLAKE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LICSW, LIMHP
Contact information
Practice address
2786 FAIRVIEW AVE N STE 38, ROSEVILLE, MN 55113-1306
(763) 412-1993
Mailing address
4905 31ST AVE S, MINNEAPOLIS, MN 55417-1403
(352) 551-4375
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
11498-C
NV
1041C0700X
Clinical Social Worker
13344228-3501
UT
1041C0700X
Clinical Social Worker
21854
AZ
1041C0700X
Clinical Social Worker
Primary
30850
MN
1041C0700X
Clinical Social Worker
3594
NE
1041C0700X
Clinical Social Worker
CSW.09929192
CO
1041C0700X
Clinical Social Worker
LW61539336
WA
1041C0700X
Clinical Social Worker
SW16639
FL
Other
Enumeration date
06/04/2020
Last updated
02/06/2025
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