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NPI Code Detail

MEDICARE: DR. CORINNA M COSTELLO PHD, LPC, ATR-BC

MEDICARE: DR. CORINNA M COSTELLO PHD, LPC, ATR-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor180-005808IL
2101YM0800XMental Health CounselorS12959NC

General Provider Information

NPI Number : 1164431136
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORINNA M COSTELLO PHD, LPC, ATR-BC
Provider Business Mailing Address
First Line : 10130 MALLARD CREEK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-6001
Country : US
Telephone Number : 980-257-1114
Fax Number :
Provider Business Practice Location Address
First Line : 10130 MALLARD CREEK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-6001
Country : US
Telephone Number : 980-257-1114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2006
Last Update Date : 02/23/2020

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Directions to “ DR. CORINNA M COSTELLO PHD, LPC, ATR-BC” Practice Location

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