Individual
AWA CISSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1582 N WAGGONER RD STE A, BLACKLICK, OH 43004-8669
(614) 344-0419
Mailing address
2540 BILLINGSLEY RD, COLUMBUS, OH 43235-1990
(614) 470-2018
(614) 953-2802
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/11/2024
Last updated
08/20/2025
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