| Square One Gjm | |
|
49 Olive St Gallipolis OH 45631-1632 | |
| (740) 441-5809 | |
| (740) 578-9242 |
| Full Name | Square One Gjm |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 49 Olive St, Gallipolis, Ohio |
| Authorized Official Name and Position | Amy Sisson (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7404415809 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Square One Gjm Po Box 272 Gallipolis OH 45631-0272 Ph: (740) 441-5809 | Square One Gjm 49 Olive St Gallipolis OH 45631-1632 Ph: (740) 441-5809 |
| NPI Number | 1952022964 |
|---|---|
| Provider Enumeration Date | 09/07/2022 |
| Last Update Date | 07/19/2023 |
| Certification Date | 07/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952022964 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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