Healthcare Provider Details

I. General information

NPI: 1043510191
Provider Name (Legal Business Name): DIANE K GUIDICI MFT, MIN.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 NANA PL # 1
KAPAA HI
96746-1369
US

IV. Provider business mailing address

341 NANA PL # 1
KAPAA HI
96746-1369
US

V. Phone/Fax

Practice location:
  • Phone: 808-821-1940
  • Fax:
Mailing address:
  • Phone: 808-821-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberHI 2012-02432
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 21066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: