Healthcare Provider Details

I. General information

NPI: 1437714359
Provider Name (Legal Business Name): THERESA-MARIE KALEIALOHA KAIO SOARES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85-888 FARRINGTON HWY
WAIANAE HI
96792-2403
US

IV. Provider business mailing address

86-226 FARRINGTON HWY
WAIANAE HI
96792-3128
US

V. Phone/Fax

Practice location:
  • Phone: 808-696-9498
  • Fax:
Mailing address:
  • Phone: 808-696-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: