Healthcare Provider Details

I. General information

NPI: 1699216556
Provider Name (Legal Business Name): MADELINE KEKIPI MHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELINE LOLANI KEKIPI MHC, NCC

II. Dates (important events)

Enumeration Date: 03/12/2017
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86-088 FARRINGTON HWY STE C107
WAIANAE HI
96792-3067
US

IV. Provider business mailing address

PO BOX 151
WAIANAE HI
96792-0151
US

V. Phone/Fax

Practice location:
  • Phone: 808-306-6333
  • Fax: 808-696-1179
Mailing address:
  • Phone: 808-306-6333
  • Fax: 808-696-1179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC 229
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: