Provider Demographics
NPI:1588089619
Name:MONTALVO, MARIO (LCAS)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3787
Mailing Address - Country:US
Mailing Address - Phone:828-475-1804
Mailing Address - Fax:828-475-4143
Practice Address - Street 1:222 W UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3787
Practice Address - Country:US
Practice Address - Phone:828-475-1804
Practice Address - Fax:828-475-4143
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20123101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)