Healthcare Provider Details

I. General information

NPI: 1952836538
Provider Name (Legal Business Name): ADRIENNE KADOOKA PSYD, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-270 WILLIAM HENRY RD STE 207
KANEOHE HI
96744-5808
US

IV. Provider business mailing address

PO BOX 1221
AIEA HI
96701-1221
US

V. Phone/Fax

Practice location:
  • Phone: 808-201-4208
  • Fax:
Mailing address:
  • Phone: 808-201-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-892
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2219
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: