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General NPI Number Information
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NPI Number | 1073656021
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Entity Type | Organization
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Legal Business Name | WINDS OF CHANGE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 2-2514 KAUMUALII HWY STE 104
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City | KALAHEO
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State | HI
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Zip | 96741-8303
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Country | US
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Telephone | 808-332-8370
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Fax | 808-332-6352
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Provider Business Mailing Address
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Address Line | PO BOX 690107
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City | MAKAWELI
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State | HI
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Zip | 96769-0107
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Country | US
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Telephone | 808-332-8370
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Fax | 808-332-6352
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER LYNN ADAMS
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Credential | PH.D.
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Telephone | 808-332-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 971
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License Number State | HI
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