Healthcare Provider Details

I. General information

NPI: 1508098773
Provider Name (Legal Business Name): LISA RENEE KAMAKA'ALA MFT, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 ULUNIU ST SUITE 100B
KAILUA HI
96734-2528
US

IV. Provider business mailing address

PO BOX 4394
KANEOHE HI
96744-8394
US

V. Phone/Fax

Practice location:
  • Phone: 808-206-0928
  • Fax:
Mailing address:
  • Phone: 808-206-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number361
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: