Provider Demographics
NPI:1851779508
Name:NISSEN, JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:NISSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 ROLLINS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7117
Mailing Address - Country:US
Mailing Address - Phone:601-624-2437
Mailing Address - Fax:
Practice Address - Street 1:11433 BAYSTONE PL
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-9107
Practice Address - Country:US
Practice Address - Phone:601-624-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical