Most Relevant Information
Provider Data
| NPI Number: | 1003527706 |
| Provider Name: | JONATHAN SULLIVAN PRSS |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/13/2022 |
| Last Updated: | 12/13/2022 |
Provider Practice Location
2333 MACCORKLE AVE STE 201
SAINT ALBANS
WV
251772074
Practice Location Phone/Fax
| Phone: | 3047660060 |
| Fax: |
Provider Mailing Location
2333 MACCORKLE AVE STE 201
SAINT ALBANS
WV
251772074
Provider Mailing Phone/Fax
| Phone: | 3047660060 |
| Fax: |