Healthcare Provider Details

I. General information

NPI: 1972627818
Provider Name (Legal Business Name): STEPHANIE MISAKI WHITING MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 EMMALANI DR
PRINCEVILLE HI
96722-5417
US

IV. Provider business mailing address

4477 EMMALANI DR
PRINCEVILLE HI
96722-5417
US

V. Phone/Fax

Practice location:
  • Phone: 715-343-5256
  • Fax:
Mailing address:
  • Phone: 808-639-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: