Healthcare Provider Details

I. General information

NPI: 1093623936
Provider Name (Legal Business Name): STILLWATER WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 KEOKEA LOOP
HILO HI
96720-4980
US

IV. Provider business mailing address

15-2660 PAHOA VILLAGE RD STE 203-639
PAHOA HI
96778-6720
US

V. Phone/Fax

Practice location:
  • Phone: 808-481-6292
  • Fax:
Mailing address:
  • Phone: 808-481-6292
  • 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: LISA LUCIA
Title or Position: BUSINESS OWNER
Credential:
Phone: 808-481-6292