Kenita A. Sullivan | Atlanta, GA • PECOS Search

Kenita A. Sullivan

Counselor

Behavioral Health & Social Service Providers

2870 Pharr Court South NW Apt 2404, Atlanta, GA 30305-2181

PECOS Enrollment

Based on the most recent information from CMS, provider Kenita A. Sullivan does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1205306990
Provider Type
Individual
Full Name
Sullivan, Kenita A.
Gender
Female

Sole Proprietor
No
Enumeration Date
11/26/2018
Last Updated
11/26/2018

Contact Information

Practice Location

2870 Pharr Court South NW Apt 2404, Atlanta, GA 30305-2181

Unlisted Fax

Mailing Location

2870 Pharr Court South NW Apt 2404, Atlanta, GA 30305-2181

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer