Healthcare Provider Details

I. General information

NPI: 1790600559
Provider Name (Legal Business Name): JACLYN WHITTINGTON AMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ULUNIU ST STE A
KAILUA HI
96734-2503
US

IV. Provider business mailing address

165 EUCALYPTUS PL
HONOLULU HI
96818-1269
US

V. Phone/Fax

Practice location:
  • Phone: 808-353-5519
  • Fax:
Mailing address:
  • Phone: 808-764-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCP-6
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: