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General NPI Number Information
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NPI Number | 1578931168
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Entity Type | Individual
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Provider Name | MAITA DE LEON MARKS LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2015
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 98-211 PALI MOMI ST STE 600
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City | AIEA
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State | HI
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Zip | 96701-4337
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Country | US
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Telephone | 808-600-1132
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Fax |
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Provider Business Mailing Address
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Address Line | 5113 IROQUOIS AVE UNIT B
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City | EWA BEACH
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State | HI
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Zip | 96706-3235
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Country | US
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Telephone | 808-600-1132
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT153685
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT-737
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License Number State | HI
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