Provider Demographics
NPI:1821403395
Name:NORTHSTAR ACADEMY LLC
Entity Type:Organization
Organization Name:NORTHSTAR ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CRC-MAC
Authorized Official - Phone:301-509-9033
Mailing Address - Street 1:12300 TWINBROOK PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1606
Mailing Address - Country:US
Mailing Address - Phone:301-509-9033
Mailing Address - Fax:
Practice Address - Street 1:12300 TWINBROOK PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1606
Practice Address - Country:US
Practice Address - Phone:301-509-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1345101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty