Healthcare Provider Details

I. General information

NPI: 1578615514
Provider Name (Legal Business Name): BIG ISLAND SUBSTANCE ABUSE COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 WAIANUENUE AVENUE
HILO HI
96720-2438
US

IV. Provider business mailing address

16-179 MELEKAHIWA STREET
KEA'AU HI
96749
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-4927
  • Fax: 808-934-8067
Mailing address:
  • Phone: 808-969-9994
  • Fax: 808-969-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateHI

VIII. Authorized Official

Name: DR. HANNAH K PRESTON-PITA
Title or Position: CEO
Credential: PSY.D
Phone: 808-969-9994