Provider Demographics
NPI:1063526325
Name:SULLIVAN, JOSEPH DAVID (LPC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DAVID
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CENTERVIEW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4311
Mailing Address - Country:US
Mailing Address - Phone:501-224-0318
Mailing Address - Fax:
Practice Address - Street 1:1701 CENTERVIEW DR STE 102
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4311
Practice Address - Country:US
Practice Address - Phone:501-224-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0211045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP0211045OtherLPC LICENSE NUMBER