Provider Demographics
NPI:1801977194
Name:BRIAN S HISSOM AND ASSOCIATES PLLC
Entity type:Organization
Organization Name:BRIAN S HISSOM AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HISSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:828-485-2195
Mailing Address - Street 1:321 7TH ST NE STE B
Mailing Address - Street 2:
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 STE B
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005884Medicaid