Provider Demographics
NPI:1760214209
Name:SULLIVAN, MOLLY (MA, LPCC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7165 S GAYLORD ST APT F8
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1634
Mailing Address - Country:US
Mailing Address - Phone:201-396-9820
Mailing Address - Fax:
Practice Address - Street 1:12150 E BRIARWOOD AVE UNIT 202
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6755
Practice Address - Country:US
Practice Address - Phone:720-662-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0022507101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor