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General NPI Number Information
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NPI Number | 1376202218
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Entity Type | Organization
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Legal Business Name | KUALOLI COUNSELING & PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 5476 KOLOA ROAD, 2F
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City | KOLOA
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State | HI
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Zip | 96756-9675
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Country | US
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Telephone | 808-639-7255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1075
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City | KOLOA
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State | HI
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Zip | 96756-1075
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Country | US
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Telephone | 808-639-7255
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SHANTI KAY MANZANO
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Credential | LCSW
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Telephone | 808-639-7255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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