Provider Demographics
NPI:1104996545
Name:SULLIVAN, DANIEL JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OFFICE PARK CIR STE 214A
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2572
Mailing Address - Country:US
Mailing Address - Phone:205-335-0691
Mailing Address - Fax:205-941-8074
Practice Address - Street 1:4 OFFICE PARK CIR STE 214A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2572
Practice Address - Country:US
Practice Address - Phone:205-335-0691
Practice Address - Fax:205-941-8074
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN02543103T00000X
AL1803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist