Provider Demographics
NPI:1710930631
Name:ABULSAAD, KAMAL G (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:G
Last Name:ABULSAAD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:G
Other - Last Name:ABULSAAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:410 NEW BRIDGE ST
Mailing Address - Street 2:SUTE 9-B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4739
Mailing Address - Country:US
Mailing Address - Phone:910-455-4727
Mailing Address - Fax:910-455-7676
Practice Address - Street 1:410 NEW BRIDGE ST
Practice Address - Street 2:SUTE 9-B
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4739
Practice Address - Country:US
Practice Address - Phone:910-455-4727
Practice Address - Fax:910-455-7676
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000023Medicaid
NC6000023Medicaid