Provider Demographics
NPI:1598015729
Name:ROUNDTREE, DAVID MATTHEW SR (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:ROUNDTREE
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6186 ROSEWAY CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-6509
Mailing Address - Country:US
Mailing Address - Phone:704-726-8580
Mailing Address - Fax:704-454-7154
Practice Address - Street 1:933 LOUISE AVE STE 101T
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2568
Practice Address - Country:US
Practice Address - Phone:704-726-8580
Practice Address - Fax:704-454-7154
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC122961041C0700X
NCC0104511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical