Healthcare Provider Details

I. General information

NPI: 1699686600
Provider Name (Legal Business Name): WILLIAM A MOUSSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84-578 MANUKU STREET
WAIANAE HI
96792
US

IV. Provider business mailing address

PO BOX 458
WAIANAE HI
96792-0458
US

V. Phone/Fax

Practice location:
  • Phone: 808-306-9842
  • Fax:
Mailing address:
  • Phone: 808-306-9842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number832-97
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: