Organization
CISSELSALTERNATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARION WILSON CISSEL 12/07/46 (OWNER)
(910) 848-0216
Entity
Organization
Contact information
Practice address
126 DAVENPORT DR, RAEFORD, NC 28376-5425
(910) 848-0216
(910) 848-0216
Mailing address
126 DAVENPORT DR, RAEFORD, NC 28376-5425
(910) 848-0216
(910) 848-0216
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
MNL047109
NC
Other
Enumeration date
04/03/2008
Last updated
04/08/2008
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