Healthcare Provider Details

I. General information

NPI: 1942923040
Provider Name (Legal Business Name): CRYSTAL CHARKOWSKI MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76-5921 MAMALAHOA HWY UNIT 229
HOLUALOA HI
96725-2513
US

IV. Provider business mailing address

76-5921 MAMALAHOA HWY UNIT 229
HOLUALOA HI
96725-2513
US

V. Phone/Fax

Practice location:
  • Phone: 808-854-3418
  • Fax:
Mailing address:
  • Phone: 808-854-3418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-5380
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: