Provider Demographics
NPI:1942251665
Name:KAUL, KRISTIN NICKLA (MS, LPA, HSP-PA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICKLA
Last Name:KAUL
Suffix:
Gender:F
Credentials:MS, LPA, HSP-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-8507
Mailing Address - Country:US
Mailing Address - Phone:252-335-2018
Mailing Address - Fax:252-335-9521
Practice Address - Street 1:1129 HORSESHOE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8507
Practice Address - Country:US
Practice Address - Phone:252-335-2018
Practice Address - Fax:252-335-9521
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2172103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107217Medicaid
NC139VPOtherBC/BS