Healthcare Provider Details

I. General information

NPI: 1801159231
Provider Name (Legal Business Name): CANDICE JOY SUTTON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 BISHOP ST STE 1103
HONOLULU HI
96813-3304
US

IV. Provider business mailing address

2579 KEKUANONI ST
HONOLULU HI
96813-1120
US

V. Phone/Fax

Practice location:
  • Phone: 808-425-7718
  • Fax:
Mailing address:
  • Phone: 808-256-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-1812
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: