Kenisha Sullivan, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC019492 Issued in PA

Practice address

1120 W Township Line Rd Ste 200
Havertown, PA 19083-4930

Phone

(484) 451-8313

NPI assigned

Aug 1, 2023

Last updated

Oct 16, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Greater Philadelphia Health Action Inc.

  dba GPHA Woodland Ave. Behavioral Healthcare

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1205140902
  Medicare reassignment
• Greater Philadelphia Health Action Inc.

  dba GPHA Southeast Health Center

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1417902362
  NPD
• Greater Philadelphia Health Action, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1275151607
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1437831328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 W ALLEGHENY AVE APT 327",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191321134",
            "telephone_number": "267-648-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 W TOWNSHIP LINE RD STE 200",
            "city": "HAVERTOWN",
            "state": "PA",
            "postal_code": "190834930",
            "telephone_number": "484-451-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "KENISHA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-01",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC019492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Nelson Strine, PSY.D.
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• Suburban Oral Surgery, PC
• Heather M Sullivan, CRNA
• Sunrise Human Care Services Inc
• Sunshine Therapy Club II
• Sunshine Therapy Club II, Inc.
• Sunshine Therapy Club Inc
• Sunshine Therapy Club, Inc

• Professional Counselor in Havertown, PA
• Providers in Havertown, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.