Healthcare Provider Details

I. General information

NPI: 1063765311
Provider Name (Legal Business Name): DARISSA M.K. KEKUAWELA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AUPUNI ST STE 118
HILO HI
96720-4260
US

IV. Provider business mailing address

PO BOX 1422
PAHOA HI
96778-1422
US

V. Phone/Fax

Practice location:
  • Phone: 808-345-3307
  • Fax:
Mailing address:
  • Phone: 808-345-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-273
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: