Individual
MR. MICHAEL LEONARD SISSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7010 E BOGARD RD, WASILLA, AK 99654-4711
(907) 373-4732
(907) 146-4749
Mailing address
PO BOX 876741, WASILLA, AK 99687-6741
(907) 373-4732
(907) 746-4749
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/06/2019
Last updated
09/07/2023
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