Provider Demographics
NPI:1861073892
Name:SULLIVAN, KAROLYN NICOLE (MA, LPC)
Entity type:Individual
Prefix:
First Name:KAROLYN
Middle Name:NICOLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 VINE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1906
Mailing Address - Country:US
Mailing Address - Phone:314-306-3275
Mailing Address - Fax:
Practice Address - Street 1:9666 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3013
Practice Address - Country:US
Practice Address - Phone:314-991-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018017333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health