Healthcare Provider Details

I. General information

NPI: 1174453849
Provider Name (Legal Business Name): NORTHSTAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 STATE ROUTE 821
MARIETTA OH
45750-5503
US

IV. Provider business mailing address

PO BOX 462
BELPRE OH
45714-0462
US

V. Phone/Fax

Practice location:
  • Phone: 220-225-9402
  • Fax:
Mailing address:
  • Phone: 220-225-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: J SIMMONS
Title or Position: DIRECTOR
Credential:
Phone: 220-225-9402