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General NPI Number Information
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NPI Number | 1508745290
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Entity Type | Individual
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Provider Name | GABRIELLE CORICE BOSTICK LMFTA
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Gender | Female
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 8535 CLIFF CAMERON DR STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28269-5909
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Country | US
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Telephone | 704-717-7477
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Fax | 704-717-7457
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Provider Business Mailing Address
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Address Line | 5020 RIDGE RD UNIT 4108
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City | CHARLOTTE
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State | NC
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Zip | 28269-0256
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Country | US
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Telephone | 843-260-2863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 10129A
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License Number State | NC
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