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General NPI Number Information
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NPI Number | 1851779508
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Entity Type | Individual
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Provider Name | JOSEPH NISSEN LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 11433 BAYSTONE PL
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City | CONCORD
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State | NC
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Zip | 28025-9107
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Country | US
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Telephone | 601-624-2437
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Fax |
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Provider Business Mailing Address
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Address Line | 4726 ROLLINS POINTE DR
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City | MONROE
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State | NC
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Zip | 28110-7117
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Country | US
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Telephone | 601-624-2437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C010807
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License Number State | NC
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