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General NPI Number Information
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NPI Number | 1386071082
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Entity Type | Organization
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Legal Business Name | WINDWARD FAMILY THERAPY CENTER
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 1600 KAPIOLANI BLVD STE 1306
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City | HONOLULU
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State | HI
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Zip | 96814-3805
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Country | US
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Telephone | 808-949-7444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37962
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City | HONOLULU
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State | HI
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Zip | 96837-0962
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MFT
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Name | SHEREE REVILLA
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Credential |
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Telephone | 808-949-7444
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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 | 253
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License Number State | HI
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