Healthcare Provider Details

I. General information

NPI: 1831315100
Provider Name (Legal Business Name): FAITH LORRAINE NORTHINGTON MS MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAITH DAVENPORT

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 5533 LUHIA ST STE # B 1A 394
KAILUA KONA HI
96740
US

IV. Provider business mailing address

74 5533 LUHIA ST STE # B 1A 394
KAILUA KONA HI
96740
US

V. Phone/Fax

Practice location:
  • Phone: 808-722-6755
  • Fax: 808-443-0213
Mailing address:
  • Phone: 808-722-6755
  • Fax: 808-443-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number169
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4006
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4245
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: