Provider Demographics
NPI:1548985898
Name:NORTH STAR WELLNESS AND RECOVERY, LLC
Entity type:Organization
Organization Name:NORTH STAR WELLNESS AND RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:501-428-6980
Mailing Address - Street 1:43 RIVER CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MAYFLOWER
Mailing Address - State:AR
Mailing Address - Zip Code:72106-8023
Mailing Address - Country:US
Mailing Address - Phone:501-428-6980
Mailing Address - Fax:
Practice Address - Street 1:1405 N PIERCE ST STE 301
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5377
Practice Address - Country:US
Practice Address - Phone:501-428-6980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty