Healthcare Provider Details

I. General information

NPI: 1962325100
Provider Name (Legal Business Name): JASON LUDINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S WAKEA AVE UNIT B
KAHULUI HI
96732-1343
US

IV. Provider business mailing address

935 E ONAHA PL
WAILUKU HI
96793-9481
US

V. Phone/Fax

Practice location:
  • Phone: 808-585-1424
  • Fax:
Mailing address:
  • Phone: 951-644-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: