Healthcare Provider Details

I. General information

NPI: 1265954218
Provider Name (Legal Business Name): INSPIRE4PURPOSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NW 183RD ST STE 404
MIAMI FL
33169-4619
US

IV. Provider business mailing address

111 NW 183RD ST STE 404
MIAMI FL
33169-4619
US

V. Phone/Fax

Practice location:
  • Phone: 786-524-4001
  • Fax: 786-551-1968
Mailing address:
  • Phone: 786-524-4001
  • Fax: 786-551-1968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALTHERESA CLARK
Title or Position: CEO
Credential:
Phone: 786-223-8181