Provider Demographics
NPI:1366151367
Name:SULLIVAN, CHRISTIANNA LYNN (LCSW LCPC)
Entity type:Individual
Prefix:MS
First Name:CHRISTIANNA
Middle Name:LYNN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LCSW LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 S GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3608
Mailing Address - Country:US
Mailing Address - Phone:217-553-6678
Mailing Address - Fax:
Practice Address - Street 1:351 WILLIAMS LN
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1044
Practice Address - Country:US
Practice Address - Phone:217-553-6678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011835101YP2500X
IL1490202761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional