Healthcare Provider Details

I. General information

NPI: 1780129874
Provider Name (Legal Business Name): MISS CANDEE DIONE RILLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 08/31/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-2760 KUMU ST
PAHOA HI
96778-9205
US

IV. Provider business mailing address

15-2760 KUMU ST
PAHOA HI
96778-9205
US

V. Phone/Fax

Practice location:
  • Phone: 808-895-0458
  • Fax:
Mailing address:
  • Phone: 808-895-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number780
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: