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General NPI Number Information
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NPI Number | 1538601778
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Entity Type | Organization
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Legal Business Name | GREAT NORTH COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 310 4TH AVE S STE 5010 PMB 91823
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1053
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Country | US
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Telephone | 218-214-6096
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Fax | 888-972-3614
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Provider Business Mailing Address
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Address Line | 310 4TH AVE S STE 5010 PMB 91823
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1053
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Country | US
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Telephone | 218-214-6096
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Fax | 888-972-3614
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Authorized Official
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Title or Position | BUSINESS OWNER, PRIMARY CLINICIAN
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Name | MRS. KIMBERLY CARROLL
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Credential | LADC, LPCC
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Telephone | 218-214-6096
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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 | 304598
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1892
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License Number State | MN
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