Individual
AMANDA LYNN CISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
439 S ROSS ST, BEAVERTON, MI 48612-9101
(989) 422-5122
Mailing address
9249 W LAKE CITY RD, HOUGHTON LAKE, MI 48629-9602
(989) 422-5122
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801091799
MI
Other
Enumeration date
02/20/2013
Last updated
03/17/2018
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