Provider Demographics
NPI:1891062261
Name:OSTRISHKO, GAIL (LPC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:OSTRISHKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:OSTRISHKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:42 BERMUDA LANDING PL
Mailing Address - Street 2:
Mailing Address - City:N TOPSAIL BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28460-8557
Mailing Address - Country:US
Mailing Address - Phone:919-219-2666
Mailing Address - Fax:919-779-0727
Practice Address - Street 1:13500 HWY 50
Practice Address - Street 2:SUITE 101
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445
Practice Address - Country:US
Practice Address - Phone:919-219-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional