Provider Demographics
NPI:1225594260
Name:NORTHSTAR COUNSELING & WELLNESS, LLC
Entity type:Organization
Organization Name:NORTHSTAR COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:O
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-834-8394
Mailing Address - Street 1:650 RITCHIE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3935
Mailing Address - Country:US
Mailing Address - Phone:410-834-8394
Mailing Address - Fax:
Practice Address - Street 1:650 RITCHIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3935
Practice Address - Country:US
Practice Address - Phone:410-834-8394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty