Provider Demographics
NPI:1104391192
Name:GISSER, MICHAEL (MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GISSER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 GRANITE MILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4569
Mailing Address - Country:US
Mailing Address - Phone:336-825-5433
Mailing Address - Fax:
Practice Address - Street 1:1140 KILDAIRE FARM RD
Practice Address - Street 2:STE 206
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4597
Practice Address - Country:US
Practice Address - Phone:336-825-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral