Healthcare Provider Details

I. General information

NPI: 1881139194
Provider Name (Legal Business Name): CHRISTIN DECOITO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date: 09/22/2025
Reactivation Date: 11/12/2025

III. Provider practice location address

18-4104 HOLANA ST
VOLCANO HI
96785
US

IV. Provider business mailing address

74 TODD AVE
HILO HI
96720-4849
US

V. Phone/Fax

Practice location:
  • Phone: 808-443-7308
  • Fax:
Mailing address:
  • Phone: 808-443-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-1153
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: