Healthcare Provider Details

I. General information

NPI: 1104749373
Provider Name (Legal Business Name): INSTITUTE OF PURPOSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11433 BAYSTONE PL
CONCORD NC
28025-9107
US

IV. Provider business mailing address

11433 BAYSTONE PL
CONCORD NC
28025-9107
US

V. Phone/Fax

Practice location:
  • Phone: 601-624-2437
  • Fax:
Mailing address:
  • Phone: 601-624-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH EDWARD NISSEN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 800-878-1950