Healthcare Provider Details

I. General information

NPI: 1174897946
Provider Name (Legal Business Name): TZADDI LEE PEARCE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-902 ALENA LOOP
WAIALUA HI
96791-9726
US

IV. Provider business mailing address

66-216 FARRINGTON HWY SUITE 204
WAIALUA HI
96791
US

V. Phone/Fax

Practice location:
  • Phone: 808-782-4417
  • Fax:
Mailing address:
  • Phone: 808-782-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number297
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: