Healthcare Provider Details

I. General information

NPI: 1073161402
Provider Name (Legal Business Name): JACQUELINE VALOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3094 ELUA ST
LIHUE HI
96766-1209
US

IV. Provider business mailing address

3094 ELUA ST
LIHUE HI
96766-1209
US

V. Phone/Fax

Practice location:
  • Phone: 808-481-8433
  • Fax:
Mailing address:
  • Phone: 808-481-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW-5553
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLPC004501
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: