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General NPI Number Information
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NPI Number | 1538882881
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Entity Type | Individual
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Provider Name | LISA FANNING LMHC, NCC
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Gender | Female
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 95 E LIPOA ST STE A210
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City | KIHEI
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State | HI
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Zip | 96753-8193
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Country | US
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Telephone | 808-419-8105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 646
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City | WAILUKU
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State | HI
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Zip | 96793-0646
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MHC-1031-0
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License Number State | HI
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