Provider Demographics
NPI:1316716061
Name:SULLIVAN, KATHERINE BERES (MED, CSACS)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BERES
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MED, CSACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 N ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3405
Mailing Address - Country:US
Mailing Address - Phone:703-568-3585
Mailing Address - Fax:
Practice Address - Street 1:8150 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7715
Practice Address - Country:US
Practice Address - Phone:703-568-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0709025087101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)