Provider Demographics
NPI:1073151429
Name:GORELICK, JOSHUA (LCMHC, LCAS-A)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GORELICK
Suffix:
Gender:M
Credentials:LCMHC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 SULLIVAN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9417
Mailing Address - Country:US
Mailing Address - Phone:704-426-3453
Mailing Address - Fax:
Practice Address - Street 1:8015 SULLIVAN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-9417
Practice Address - Country:US
Practice Address - Phone:704-426-3453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14972101YM0800X
NC14972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health