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General NPI Number Information
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NPI Number | 1336760222
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Entity Type | Organization
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Legal Business Name | NORTHSTAR CLINICAL SERVICES
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 322 LAMAR AVE STE 220
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City | CHARLOTTE
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State | NC
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Zip | 28204-2436
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Country | US
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Telephone | 980-237-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 322 LAMAR AVE STE 220
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City | CHARLOTTE
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State | NC
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Zip | 28204-2436
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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 | CEO
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Name | DERRICK JOHNSON
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Credential |
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Telephone | 980-505-2353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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