Individual
CRYSTAL NOEL SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
1015 S BROADWAY, SUITE 18, MINOT, ND 58701-4667
(701) 857-8500
(701) 857-8555
Mailing address
1015 S BROADWAY, SUITE 18, MINOT, ND 58701-4667
(701) 857-8500
(701) 857-8555
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1295
MT
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1765
ND
Other
Enumeration date
07/13/2010
Last updated
06/12/2015
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