=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275984676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNSELING ALTERNATIVES FOR RECOVERY MAINTENANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2016
-----------------------------------------------------
Last Update Date | 06/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1793 KEKAULIKE AVE
-----------------------------------------------------
City | KULA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96790-8920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-228-9450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 901420
-----------------------------------------------------
City | KULA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96790-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-228-9450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHELE SCOFIELD
-----------------------------------------------------
Credential | PHD, LCSW, CSAC
-----------------------------------------------------
Telephone | 808-228-9450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW4122
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW 4122
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------