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General NPI Number Information
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NPI Number | 1124212261
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Entity Type | Organization
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Legal Business Name | CREATIVE ARTS CENTER
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 7773 WAIKAPU LOOP
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City | HONOLULU
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State | HI
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Zip | 96825-3026
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Country | US
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Telephone | 808-222-2664
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Fax |
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Provider Business Mailing Address
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Address Line | 7773 WAIKAPU LOOP
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City | HONOLULU
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State | HI
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Zip | 96825-3026
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Country | US
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Telephone | 808-222-2664
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Fax | 808-395-0787
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. XANYA SOFRA-WEISS
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Credential | PH.D
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Telephone | 808-222-2664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSYCHOLOGY 520
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License Number State | HI
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