Provider Demographics
NPI:1730372814
Name:SULLIVAN, TONGIA (AMFT)
Entity type:Individual
Prefix:MS
First Name:TONGIA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 W CESAR CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3922
Mailing Address - Country:US
Mailing Address - Phone:559-250-9979
Mailing Address - Fax:
Practice Address - Street 1:811 S PARALLEL AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2456
Practice Address - Country:US
Practice Address - Phone:559-759-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAA015560315101YA0400X
CA112663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)