Healthcare Provider Details

I. General information

NPI: 1841650082
Provider Name (Legal Business Name): BIG ISLAND TEEN COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 KAMEHAMEHA AVE SUITE 206
HILO HI
96720-2860
US

IV. Provider business mailing address

PO BOX 10283
HILO HI
96721-5283
US

V. Phone/Fax

Practice location:
  • Phone: 808-494-5350
  • Fax:
Mailing address:
  • Phone: 808-494-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number4014
License Number StateHI

VIII. Authorized Official

Name: MS. SARAH LOUISE WARREN
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 808-494-5350