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Individual
DR. CHARLES MICHAEL KISSICK
Active
Individual
DR. CHARLES MICHAEL KISSICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC, LPC, ICAADC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC04707
OK
101YA0400X
Addiction (Substance Use Disorder) Counselor
844
OK
Other
Enumeration date
03/10/2009
Last updated
08/20/2024
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