Healthcare Provider Details

I. General information

NPI: 1093904948
Provider Name (Legal Business Name): SAMARITAN COUNSELING CENTER HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S BERETANIA ST
HONOLULU HI
96814-1428
US

IV. Provider business mailing address

1020 S BERETANIA ST
HONOLULU HI
96814-1428
US

V. Phone/Fax

Practice location:
  • Phone: 808-545-2740
  • Fax: 808-545-2852
Mailing address:
  • Phone: 808-545-2740
  • Fax: 808-545-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE CHANG
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 808-545-2740