Healthcare Provider Details

I. General information

NPI: 1235066564
Provider Name (Legal Business Name): NORTHSTAR THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5468 INGATE WAY
RALEIGH NC
27613-7844
US

IV. Provider business mailing address

5468 INGATE WAY
RALEIGH NC
27613-7844
US

V. Phone/Fax

Practice location:
  • Phone: 651-428-7930
  • Fax:
Mailing address:
  • Phone: 651-428-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARK JOSEPH BERTELSEN
Title or Position: CEO
Credential: MFT
Phone: 651-428-7930