Provider Demographics
NPI:1750822656
Name:NORTHERN SHORES COUNSELING
Entity Type:Organization
Organization Name:NORTHERN SHORES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS-POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-235-8200
Mailing Address - Street 1:413 W HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5134
Mailing Address - Country:US
Mailing Address - Phone:906-235-8200
Mailing Address - Fax:
Practice Address - Street 1:413 W HAMPTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5134
Practice Address - Country:US
Practice Address - Phone:906-235-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty