Healthcare Provider Details

I. General information

NPI: 1083016224
Provider Name (Legal Business Name): PACIFIC COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87-226 HOLOMALIA PL
WAIANAE HI
96792-3706
US

IV. Provider business mailing address

87-226 HOLOMALIA PL
WAIANAE HI
96792-3706
US

V. Phone/Fax

Practice location:
  • Phone: 808-291-8582
  • Fax:
Mailing address:
  • Phone: 808-291-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA J. LEWIS
Title or Position: OWNER
Credential:
Phone: 808-291-8582