Healthcare Provider Details

I. General information

NPI: 1215545991
Provider Name (Legal Business Name): AUTISM INTERVENTION MANAGEMENT INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S KUKUI ST APT 3211
HONOLULU HI
96813-2327
US

IV. Provider business mailing address

55 S KUKUI ST APT 3211
HONOLULU HI
96813-2327
US

V. Phone/Fax

Practice location:
  • Phone: 808-393-9826
  • Fax:
Mailing address:
  • Phone: 808-393-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DIANNA ATAY
Title or Position: DIRECTOR
Credential: BCBA
Phone: 808-393-9826