Healthcare Provider Details

I. General information

NPI: 1265337208
Provider Name (Legal Business Name): THREE ROOTS CLINICAL COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 DAIRY RD STE E302
KAHULUI HI
96732-2348
US

IV. Provider business mailing address

415 DAIRY RD STE E302
KAHULUI HI
96732-2348
US

V. Phone/Fax

Practice location:
  • Phone: 808-303-9816
  • Fax:
Mailing address:
  • Phone: 808-303-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. ALISON J BROMLEY
Title or Position: OWNER/PARTNER
Credential: LCSW
Phone: 808-303-9816