Provider Demographics
NPI:1194372029
Name:NORTHSTAR CLINICAL SERVICES
Entity Type:Organization
Organization Name:NORTHSTAR CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL PROJECT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOYES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:919-285-1593
Mailing Address - Street 1:322 LAMAR AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 LAMAR AVE STE 220
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2436
Practice Address - Country:US
Practice Address - Phone:980-237-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder