Provider Demographics
NPI:1588897748
Name:GHANDOUR, BILAL M (PH D)
Entity type:Individual
Prefix:
First Name:BILAL
Middle Name:M
Last Name:GHANDOUR
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10440 PARK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8544
Mailing Address - Country:US
Mailing Address - Phone:980-237-4766
Mailing Address - Fax:980-404-2274
Practice Address - Street 1:6115 PARK SOUTH DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3269
Practice Address - Country:US
Practice Address - Phone:704-552-0116
Practice Address - Fax:704-552-7550
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102851103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist