Provider Demographics
NPI:1508745290
Name:BOSTICK, GABRIELLE CORICE (LMFTA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:CORICE
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 RIDGE RD UNIT 4108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0256
Mailing Address - Country:US
Mailing Address - Phone:843-260-2863
Mailing Address - Fax:
Practice Address - Street 1:7504 E INDEPENDENCE BLVD STE 109
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-9454
Practice Address - Country:US
Practice Address - Phone:704-457-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10129A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist