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General NPI Number Information
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NPI Number | 1033286794
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN BRIEF THERAPY, INC.
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 4346 STARKEY RD SUITE 1
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City | ROANOKE
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State | VA
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Zip | 24018-0605
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Country | US
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Telephone | 540-772-8043
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Fax | 540-772-8242
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Provider Business Mailing Address
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Address Line | 4346 STARKEY RD SUITE 1
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City | ROANOKE
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State | VA
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Zip | 24018-0605
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Country | US
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Telephone | 540-772-8043
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Fax | 540-772-8242
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. DAVID LINN MORTELLARO
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Credential | LPC, LMFT
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Telephone | 540-772-8043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701001496
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License Number State | VA
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