Healthcare Provider Details

I. General information

NPI: 1992531925
Provider Name (Legal Business Name): DYNAMIC HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N VINEYARD BLVD STE B130
HONOLULU HI
96817-3950
US

IV. Provider business mailing address

PO BOX 60599
EWA BEACH HI
96706-7599
US

V. Phone/Fax

Practice location:
  • Phone: 808-425-4245
  • Fax:
Mailing address:
  • Phone: 808-664-1104
  • Fax: 866-592-3149

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: DR. ANNIE ANDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY.D, CSAC
Phone: 808-489-2486