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General NPI Number Information
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NPI Number | 1104462175
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Entity Type | Individual
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Provider Name | MR. LADARIEN JAREY GILLINS
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Gender | Male
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 1221 KAPIOLANI BLVD
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City | HONOLULU
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State | HI
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Zip | 96814-3503
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Country | US
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Telephone | 808-260-9893
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Fax |
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Provider Business Mailing Address
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Address Line | 78C LAKEVIEW CIR APT C
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City | WAHIAWA
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State | HI
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Zip | 96786-1529
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Country | US
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Telephone | 214-641-2289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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