Healthcare Provider Details

I. General information

NPI: 1538070016
Provider Name (Legal Business Name): JAIE K VICTORINE-DYMENT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 KAMEHAMEHA AVE STE 201
HILO HI
96720-2878
US

IV. Provider business mailing address

360 LAMA ST APT B
HILO HI
96720-5892
US

V. Phone/Fax

Practice location:
  • Phone: 808-825-4214
  • Fax:
Mailing address:
  • Phone: 808-268-0445
  • 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: