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General NPI Number Information
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NPI Number | 1548985898
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Entity Type | Organization
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Legal Business Name | NORTH STAR WELLNESS AND RECOVERY, LLC
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 1405 N PIERCE ST STE 301
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City | LITTLE ROCK
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State | AR
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Zip | 72207-5377
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Country | US
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Telephone | 501-428-6980
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Fax |
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Provider Business Mailing Address
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Address Line | 43 RIVER CLIFF DR
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City | MAYFLOWER
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State | AR
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Zip | 72106-8023
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Country | US
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Telephone | 501-428-6980
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CHRISTOPHER DICKIE
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Credential | MS
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Telephone | 501-428-6980
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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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