Individual
MANDY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
635 MAIN ST, MIDDLETOWN, CT 06457-2718
(860) 347-6971
(860) 704-8034
Mailing address
575 MAIN ST FL 2, ATTN: CREDENTIALING DPT, MIDDLETOWN, CT 06457-2845
(860) 347-6971
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
002169
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236338
—
CT
Enumeration date
04/10/2012
Last updated
04/10/2012
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