=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346417367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAY THERAPY CENTER OF HAWAII, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2008
-----------------------------------------------------
Last Update Date | 05/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 ULUNIU ST SUITE 207
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-2523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-261-0066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 ULUNIU ST SUITE 207
-----------------------------------------------------
City | KAILUA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96734-2523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-261-0066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CARLA SHARP
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 808-261-0066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------