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General NPI Number Information
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NPI Number | 1063915924
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Entity Type | Individual
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Provider Name | SARAH BERTOLO LPC
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Gender | Female
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 201 CHURCH ST SE STE D
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City | BLACKSBURG
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State | VA
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Zip | 24060-4878
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Country | US
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Telephone | 540-808-6041
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Fax |
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Provider Business Mailing Address
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Address Line | 370 RAGAN DR
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073-1906
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Country | US
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Telephone | 540-808-6041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0701007520
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License Number State | VA
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