=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245039221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COURTER COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2025
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 92-1169 HOOKEHA ST
-----------------------------------------------------
City | KAPOLEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96707-1531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-214-2011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 92-1169 HOOKEHA ST
-----------------------------------------------------
City | KAPOLEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96707-1531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | AMANDA COURTER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 609-214-2011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------