Provider Demographics
NPI:1932914371
Name:SULLIVAN, ALEXANDER WILLIAM (MSW)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:WILLIAM
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:ALEC
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:7071 SANDPIPER ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-7406
Mailing Address - Country:US
Mailing Address - Phone:269-547-9730
Mailing Address - Fax:
Practice Address - Street 1:5320 HOLIDAY TER STE 3
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2100
Practice Address - Country:US
Practice Address - Phone:269-459-1512
Practice Address - Fax:269-459-1151
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511161841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty