Healthcare Provider Details

I. General information

NPI: 1790318459
Provider Name (Legal Business Name): ERIN SULLIVAN KUYKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2128 OLD FORT WEAVER ROAD
EWA HI
96706
US

IV. Provider business mailing address

91-2128 OLD FORT WEAVER ROAD
EWA HI
96706
US

V. Phone/Fax

Practice location:
  • Phone: 808-589-1829
  • Fax:
Mailing address:
  • Phone: 808-589-1829
  • Fax:

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:
Title or Position:
Credential:
Phone: