Healthcare Provider Details

I. General information

NPI: 1467181941
Provider Name (Legal Business Name): THEROHANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 KAMAAHA AVE APT 402
KAPOLEI HI
96707-4640
US

IV. Provider business mailing address

550 KAMAAHA AVE APT 402
KAPOLEI HI
96707-4640
US

V. Phone/Fax

Practice location:
  • Phone: 808-208-6615
  • Fax:
Mailing address:
  • Phone: 808-208-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLEEN MCDUFFIE
Title or Position: THERAPIST
Credential: LMFT
Phone: 808-208-6615