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General NPI Number Information
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NPI Number | 1073707014
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Entity Type | Individual
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Provider Name | GLORIA SMITH CISSE LPC, LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 3835 VINEVILLE AVE
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City | MACON
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State | GA
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Zip | 31204-1864
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Country | US
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Telephone | 478-471-7785
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Fax |
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Provider Business Mailing Address
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Address Line | 2093 E NAPIER AVE
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City | MACON
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State | GA
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Zip | 31204-3617
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Country | US
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Telephone | 478-743-8288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 004607
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 003871
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License Number State | GA
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