Northridge Counseling Centre Inc

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1054 Issued in ND

Legal business name

NORTHRIDGE COUNSELING CENTRE INC

Practice address

215 N 3Rd Street
Suite 202a
Grand Forks, ND 58203

Phone

(701) 772-7203

Fax

(701) 772-7204

NPI assigned

Dec 28, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John Patrick Hennessy, LAC NCAC II

Title

Owner Counselor Program Director

Phone

(701) 772-7203

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912063587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N 3RD STREET",
            "address_2": "SUITE 202A",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58203",
            "telephone_number": "701-772-7203",
            "fax_number": "701-772-7204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N 3RD STREET",
            "address_2": "SUITE 202A",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58203",
            "telephone_number": "701-772-7203",
            "fax_number": "701-772-7204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHRIDGE COUNSELING CENTRE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENNESSY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER COUNSELOR PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "701-772-7203",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LAC NCAC II"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ND",
            "license": "1054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.