| Great North Counseling Services, Llc | |
|
310 4th Ave S Ste 5010 Pmb 91823 Minneapolis MN 55415-1053 | |
| (218) 214-6096 | |
| (888) 972-3614 |
| Full Name | Great North Counseling Services, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 310 4th Ave S, Minneapolis, Minnesota |
| Authorized Official Name and Position | Kimberly Carroll (BUSINESS OWNER, PRIMARY CLINICIAN) |
| Authorized Official Contact | 2182146096 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great North Counseling Services, Llc 310 4th Ave S Ste 5010 Pmb 91823 Minneapolis MN 55415-1053 Ph: (218) 214-6096 | Great North Counseling Services, Llc 310 4th Ave S Ste 5010 Pmb 91823 Minneapolis MN 55415-1053 Ph: (218) 214-6096 |
| NPI Number | 1538601778 |
|---|---|
| Provider Enumeration Date | 11/04/2016 |
| Last Update Date | 08/29/2022 |
| Certification Date | 08/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538601778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 304598 (Minnesota) | Secondary |
| 101YP2500X | Counselor - Professional | 1892 (Minnesota) | Primary |
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