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Individual

CHARLES WILLIAM CISSNA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPCA

Contact information

Practice address
822 WOODWAY ST, BOWLING GREEN, KY 42101-2771
(270) 901-5000
(270) 842-5268
Mailing address
207 COLLEGE ST, HORSE CAVE, KY 42749-1210
(270) 901-5000
(270) 842-5268

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0197
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
60604011
KY
Enumeration date
11/09/2006
Last updated
07/09/2007
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