Healthcare Provider Details

I. General information

NPI: 1689595530
Provider Name (Legal Business Name): ROZELLE GIPSON LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 FAIRVIEW RD STE 770
CHARLOTTE NC
28210-3142
US

IV. Provider business mailing address

5950 FAIRVIEW RD STE 770
CHARLOTTE NC
28210-3142
US

V. Phone/Fax

Practice location:
  • Phone: 704-705-8507
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23286
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: