Provider Demographics
NPI:1598115735
Name:GILBERT, CORTEZ (LCSWA)
Entity Type:Individual
Prefix:
First Name:CORTEZ
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11723 SWEETBRIAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5049
Mailing Address - Country:US
Mailing Address - Phone:704-773-7021
Mailing Address - Fax:
Practice Address - Street 1:11723 SWEETBRIAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5049
Practice Address - Country:US
Practice Address - Phone:704-773-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2016-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0097491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical