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General NPI Number Information
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NPI Number | 1417112491
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Entity Type | Organization
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Legal Business Name | POSITIVE SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 1611 HULI RD
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City | KILAUEA
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State | HI
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Zip | 96754-5565
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Country | US
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Telephone | 808-292-7968
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 HULI RD
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City | KILAUEA
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State | HI
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Zip | 96754-5565
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Country | US
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Telephone | 808-292-7968
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | MS. CATHERINE H WILSON
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Credential | M.ED,BCBA,LMHC
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Telephone | 808-292-7968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 16
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License Number State | HI
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