Provider Demographics
NPI:1609275064
Name:SISSON, MARK D (LPCC-S)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:SISSON
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CHATHAM DR FL 4
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1405
Mailing Address - Country:US
Mailing Address - Phone:937-671-5656
Mailing Address - Fax:
Practice Address - Street 1:117 CHATHAM DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-1405
Practice Address - Country:US
Practice Address - Phone:937-671-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700312-SUPV101Y00000X
OHC1400295101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor