Healthcare Provider Details

I. General information

NPI: 1881291243
Provider Name (Legal Business Name): MINDWERKS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 KAMAKEE ST STE 305
HONOLULU HI
96814-4243
US

IV. Provider business mailing address

401 KAMAKEE ST STE 305
HONOLULU HI
96814-4243
US

V. Phone/Fax

Practice location:
  • Phone: 808-220-6236
  • Fax:
Mailing address:
  • Phone: 808-220-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HAYLIN DENNISON
Title or Position: MANAGER
Credential: LCSW
Phone: 808-364-7592