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Organization
SQUARE ONE GJM
Active
Organization
SQUARE ONE GJM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY N SISSON PHD (CLINICAL DIRECTOR)
(740) 441-5809
Entity
Organization
Contact information
Practice address
49 OLIVE ST, GALLIPOLIS, OH 45631-1632
(740) 441-5809
Mailing address
PO BOX 272, GALLIPOLIS, OH 45631-0272
(740) 441-5809
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/26/2022
Last updated
12/29/2022
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