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General NPI Number Information
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NPI Number | 1750046504
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Entity Type | Individual
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Provider Name | ALICE DEBBIE BERTOLDO
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Gender | Female
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Dates
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Enumeration Date | 11/07/2021
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Last Update Date | 11/07/2021
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Provider Practice Location Address
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Address Line | 5635 N SCOTTSDALE RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-5937
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Country | US
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Telephone | 855-284-7483
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Fax | 617-807-0958
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Provider Business Mailing Address
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Address Line | 1000 JEFFERSON ST STE 2C
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City | LYNCHBURG
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State | VA
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Zip | 24504-1724
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Country | US
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Telephone | 855-284-7483
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Fax | 617-807-0958
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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 | LPC-20063
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License Number State | AZ
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