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General NPI Number Information
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NPI Number | 1093322364
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Entity Type | Organization
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Legal Business Name | NORTHSTAR WELLNESS ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 171 DANIEL WEBSTER HWY UNIT 11
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City | BELMONT
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State | NH
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Zip | 03220-3053
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Country | US
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Telephone | 802-449-6147
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1598
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City | CAMPTON
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State | NH
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Zip | 03223-1598
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD NASSTROM
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Credential | DO
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Telephone | 802-449-6147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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