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General NPI Number Information
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NPI Number | 1851375836
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Entity Type | Individual
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Provider Name | DAVID L MORTELLARO LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 4656 BRAMBLETON AVE
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City | ROANOKE
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State | VA
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Zip | 24018-3437
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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 | 6980 HIGHFIELDS FARM CIR
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City | ROANOKE
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State | VA
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Zip | 24018-5631
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Country | US
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Telephone | 540-774-4114
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Fax | 540-772-8242
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701001496
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717000603
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License Number State | VA
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