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Individual

GLORIA SMITH CISSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC, LMSW

Contact information

Practice address
3835 VINEVILLE AVE, MACON, GA 31204-1864
(478) 471-7785
Mailing address
2093 E NAPIER AVE, MACON, GA 31204-3617
(478) 743-8288

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
004607
GA
104100000X
Social Worker
003871
GA

Other

Enumeration date
09/04/2007
Last updated
09/04/2007
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