Provider Demographics
NPI:1124758545
Name:NORTH STAR HOLISTIC HEALING A LICENSED CLINICAL SOCIAL WORKER CORP
Entity type:Organization
Organization Name:NORTH STAR HOLISTIC HEALING A LICENSED CLINICAL SOCIAL WORKER CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-587-1496
Mailing Address - Street 1:39252 WINCHESTER RD STE 107 491
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3509
Mailing Address - Country:US
Mailing Address - Phone:951-587-1496
Mailing Address - Fax:951-834-0221
Practice Address - Street 1:39252 WINCHESTER RD STE 107491
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3509
Practice Address - Country:US
Practice Address - Phone:951-587-1496
Practice Address - Fax:951-834-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty