Provider Demographics
NPI:1912191578
Name:SISSEL, MARISA CHRISTINA ELENA (LISW-CP)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:CHRISTINA ELENA
Last Name:SISSEL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SPRINGHALL DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5351
Mailing Address - Country:US
Mailing Address - Phone:435-885-7108
Mailing Address - Fax:843-429-8998
Practice Address - Street 1:111 SPRINGHALL DR UNIT B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5351
Practice Address - Country:US
Practice Address - Phone:435-885-7108
Practice Address - Fax:843-429-8998
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6036104100000X
SC158361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker