MEDICARE: BERTRESH LONDON NUNEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701010158	VA
2	101YM0800X	Mental Health Counselor	LMHC10006119	MA

General Provider Information

NPI Number	:	1487241402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTRESH LONDON NUNEZ LPC

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:	617-807-0958

Provider Business Practice Location Address
First Line	:	3804 POPLAR HILL RD UNIT D
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5532
Country	:	US
Telephone Number	:	571-934-3936
Fax Number	:	617-807-0958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	04/13/2026

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