Healthcare Provider Details

I. General information

NPI: 1518667799
Provider Name (Legal Business Name): DEBORAH WITHERS LCSW INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-825 WAIOLU PLACE
HAWI HI
96719
US

IV. Provider business mailing address

PO BOX 685
KAPAAU HI
96755-0685
US

V. Phone/Fax

Practice location:
  • Phone: 978-456-7705
  • Fax: 978-456-7705
Mailing address:
  • Phone: 978-456-7705
  • Fax: 978-456-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH A WITHERS
Title or Position: OWNER
Credential: MSW LCSW
Phone: 978-456-7705