Individual
KENNETH P. SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1104 GLENEAGLES DR SW # B, HUNTSVILLE, AL 35801-6404
(256) 880-8202
(256) 880-8234
Mailing address
1104 GLENEAGLES DR SW # B, HUNTSVILLE, AL 35801-6404
(256) 880-8202
(256) 880-8234
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
413
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000070874
—
AL
Enumeration date
01/05/2007
Last updated
07/09/2007
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