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General NPI Number Information
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NPI Number | 1114652161
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Entity Type | Individual
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Provider Name | DIONNE MALIA ISHIMURA LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/22/2022
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 94-1388 MOANIANI ST STE 207
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City | WAIPAHU
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State | HI
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Zip | 96797-6604
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Country | US
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Telephone | 808-838-9781
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17694
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City | HONOLULU
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State | HI
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Zip | 96817-0694
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Country | US
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Telephone | 808-838-9781
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-4855
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License Number State | HI
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