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General NPI Number Information
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NPI Number | 1598015729
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Entity Type | Individual
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Provider Name | DAVID MATTHEW ROUNDTREE SR. LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 933 LOUISE AVE STE 101T
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City | CHARLOTTE
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State | NC
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Zip | 28204-2568
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Country | US
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Telephone | 704-726-8580
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Fax | 704-454-7154
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Provider Business Mailing Address
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Address Line | 6186 ROSEWAY CT
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City | HARRISBURG
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State | NC
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Zip | 28075-6509
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Country | US
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Telephone | 704-726-8580
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Fax | 704-454-7154
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12296
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C010451
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License Number State | NC
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