Provider Demographics
NPI:1427460906
Name:SISSOM, CASSANDRA (LPC, LCPC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SISSOM
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PINE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4784
Mailing Address - Country:US
Mailing Address - Phone:314-479-4564
Mailing Address - Fax:
Practice Address - Street 1:103 PINE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4784
Practice Address - Country:US
Practice Address - Phone:314-479-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016036039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional