Provider Demographics
NPI:1538338330
Name:SULLIVAN, MARTHA ELAINE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ELAINE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 ALAMEDA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317
Mailing Address - Country:US
Mailing Address - Phone:305-389-5059
Mailing Address - Fax:
Practice Address - Street 1:2801 THOMASVILLE ROAD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:305-389-5059
Practice Address - Fax:267-501-0714
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health