Healthcare Provider Details

I. General information

NPI: 1336983535
Provider Name (Legal Business Name): MALAMA SERENITY PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-115 AIEA HEIGHTS DR STE 219A
AIEA HI
96701-3974
US

IV. Provider business mailing address

99-115 AIEA HEIGHTS DR STE 219A
AIEA HI
96701-3974
US

V. Phone/Fax

Practice location:
  • Phone: 808-909-2006
  • Fax: 808-909-3818
Mailing address:
  • Phone: 808-909-2006
  • Fax: 808-909-3818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MISS JOANNE SERENITY HUMPHREYS
Title or Position: OWNER
Credential: LMFT
Phone: 808-909-2006