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Individual

MR. DAVID L MORTELLARO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPC, LMFT

Contact information

Practice address
4656 BRAMBLETON AVE, ROANOKE, VA 24018-3437
(540) 772-8043
(540) 772-8242
Mailing address
6980 HIGHFIELDS FARM CIR, ROANOKE, VA 24018-5631
(540) 774-4114
(540) 772-8242

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701001496
VA
106H00000X
Marriage & Family Therapist
0717000603
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
005400431
VIRGINIA PREMIER (HMO)
VA
05
005400431
VA
01
018061
VALUE OPTIONS
VA
01
087620
SOUTHERN HEALTH/SENTARA
VA
01
132303
MANAGED HEALTH NETWORK
VA
01
285978
ANTHEM BCBS
VA
01
297608000
MAGELLAN
VA
01
349980
MAMSI
VA
01
5675123
AETNA
VA
01
69554
CIGNA BEHAVIORAL HEALTH
VA
01
JOHN DEERE
VA0101
VA
Enumeration date
12/02/2005
Last updated
10/02/2008
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