1033464623 NPI number — ASHTON LEIGH SULLIVAN LPC, ATR

Table of content: ASHTON LEIGH SULLIVAN LPC, ATR (NPI 1033464623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033464623 NPI number — ASHTON LEIGH SULLIVAN LPC, ATR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
ASHTON
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, ATR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033464623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 788
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ROYAL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29935-0788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-732-0850
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 MARINA VILLAGE LN.
Provider Second Line Business Practice Location Address:
UNIT 27
Provider Business Practice Location Address City Name:
BEAUFORT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29906-2990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-941-3482
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6860 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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