Individual
DR. CORINNA M COSTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPC, ATR-BC
Contact information
Practice address
10130 MALLARD CREEK RD STE 300, CHARLOTTE, NC 28262-6001
(980) 257-1114
Mailing address
10130 MALLARD CREEK RD STE 300, CHARLOTTE, NC 28262-6001
(980) 257-1114
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
180-005808
IL
101YM0800X
Mental Health Counselor
Primary
S12959
NC
Other
Enumeration date
08/07/2006
Last updated
02/23/2020
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