Provider Demographics
NPI:1578391322
Name:SULLIVAN, KATHRYN HOPE (MA, CADC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:HOPE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 N CENTRAL PARK AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2326
Mailing Address - Country:US
Mailing Address - Phone:919-612-2526
Mailing Address - Fax:
Practice Address - Street 1:1757 N KIMBALL AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4805
Practice Address - Country:US
Practice Address - Phone:872-216-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health