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General NPI Number Information
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NPI Number | 1508534132
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Entity Type | Organization
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Legal Business Name | GOOD GRIEF CLINIC LLC
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 752 LOWER MAIN ST
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City | WAILUKU
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State | HI
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Zip | 96793-1480
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Country | US
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Telephone | 808-364-9391
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Fax |
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Provider Business Mailing Address
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Address Line | 1731 KAMAMALU PL
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City | WAILUKU
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State | HI
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Zip | 96793-2505
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Country | US
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Telephone | 808-364-9391
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MARI M KANEMURA
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Credential | LCSW
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Telephone | 808-364-9391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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