Healthcare Provider Details

I. General information

NPI: 1376069294
Provider Name (Legal Business Name): DAVE MOORTHY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. KAIRALY SADANAM DEKSHINAMOORTHY

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SUGARLOAF CIR STE 575
DULUTH GA
30097-9804
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 404-999-7971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC0108
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008255
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: