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General NPI Number Information
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NPI Number | 1376069294
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Entity Type | Individual
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Provider Name | MR. DAVE MOORTHY
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Gender | Male
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Dates
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Enumeration Date | 08/22/2017
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 2055 SUGARLOAF CIR STE 575
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City | DULUTH
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State | GA
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Zip | 30097-9804
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Country | US
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Telephone | 404-999-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 6290 ABBOTTS BRIDGE RD STE 502
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City | JOHNS CREEK
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State | GA
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Zip | 30097-5714
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Country | US
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Telephone | 678-936-4057
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Fax | 770-623-8846
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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 | LPC008255
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C0108
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License Number State | GA
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