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General NPI Number Information
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NPI Number | 1275942591
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Entity Type | Organization
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Legal Business Name | ISLAND PARADISE COUNSELING, LLC
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 162 KINOOLE ST STE 101
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City | HILO
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State | HI
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Zip | 96720-2861
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Country | US
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Telephone | 808-935-0070
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Fax | 808-935-0070
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Provider Business Mailing Address
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Address Line | PO BOX 10068
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City | HILO
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State | HI
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Zip | 96721
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Country | US
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Telephone | 808-935-0070
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Fax | 808-935-0070
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Authorized Official
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Title or Position | MEMBER
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Name | MS. ROXY ANTOINETTE MICO
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Credential | LCSW
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Telephone | 808-935-0070
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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 |
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License Number State | HI
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