Provider Demographics
NPI:1871037176
Name:NORTH STAR COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:NORTH STAR COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:WICKMAN-FAILING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:248-252-1683
Mailing Address - Street 1:107 HARDIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-3967
Mailing Address - Country:US
Mailing Address - Phone:248-252-1683
Mailing Address - Fax:
Practice Address - Street 1:4800 WHITESPORT CIR SW STE 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6443
Practice Address - Country:US
Practice Address - Phone:248-252-1683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health