Healthcare Provider Details

I. General information

NPI: 1649106246
Provider Name (Legal Business Name): NORTHSTAR BEHAVIORAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE FL 5
TOWSON MD
21204-4763
US

IV. Provider business mailing address

200 WASHINGTON AVE FL 5
TOWSON MD
21204-4763
US

V. Phone/Fax

Practice location:
  • Phone: 443-410-4370
  • Fax:
Mailing address:
  • Phone: 443-410-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAWN ANTONIO DWIGHT SR.
Title or Position: PMHNP
Credential: DNP
Phone: 443-410-4370