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1821567611
RICHARD SULLIVAN
BOSSIER CITY, LA
NPI
1821567611
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: LA 4146)
Enumeration Date
2018-11-21
Last Update Date
2018-11-21
Business Address
RICHARD SULLIVAN
1525 FULLILOVE DR
BOSSIER CITY, LA 71112-3346
Phone number: 318-747-1111
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Mailing Address
RICHARD SULLIVAN
2000 FAIRFIELD AVENUE
SHREVEPORT, LA 71104
Phone number: 318-222-8511
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