Provider Demographics
NPI:1861903205
Name:SISLEY, MICHAEL J (CRC, LCMHC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:SISLEY
Suffix:
Gender:M
Credentials:CRC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CROMWELL DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5440
Mailing Address - Country:US
Mailing Address - Phone:252-349-8130
Mailing Address - Fax:252-631-0677
Practice Address - Street 1:708 CROMWELL DR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5440
Practice Address - Country:US
Practice Address - Phone:252-349-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
110912225C00000X
NC12924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor