Healthcare Provider Details

I. General information

NPI: 1184400319
Provider Name (Legal Business Name): ADAPTIVE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2023
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ADRIENNE KADOOKA
Title or Position: OWNER
Credential: PSYD
Phone: 808-201-4208