Healthcare Provider Details

I. General information

NPI: 1154824407
Provider Name (Legal Business Name): KIPUKA COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-1463 AWA AVE
KEAAU HI
96749
US

IV. Provider business mailing address

PO BOX 1721
KEAAU HI
96749-1721
US

V. Phone/Fax

Practice location:
  • Phone: 808-938-4393
  • Fax:
Mailing address:
  • Phone: 808-938-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LYNNE ROSE MOLLO
Title or Position: PSYCHOTHERAPIST/OWNER
Credential: LCSW
Phone: 808-938-4393