Basic Information
| Provider Information | |||||||||
| NPI: | 1053500017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHLAND COUNSELING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 SE 2ND AVE | ||||||||
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| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557443615 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1215 SE 7TH AVE | ||||||||
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| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557444201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183271105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2007 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | K. | ||||||||
| AuthorizedOfficialMiddleName: | GREG | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2183260099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.