Provider Demographics
NPI:1770683385
Name:HISSOM, BRIAN S (MA, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:HISSOM
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 7TH ST NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5113
Mailing Address - Country:US
Mailing Address - Phone:828-485-2195
Mailing Address - Fax:828-485-2197
Practice Address - Street 1:321 7TH ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5113
Practice Address - Country:US
Practice Address - Phone:828-485-2195
Practice Address - Fax:828-485-2197
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional