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General NPI Number Information
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NPI Number | 1598049140
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Entity Type | Organization
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Legal Business Name | NEW WAVES WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 3660 BALDWIN AVE
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City | MAKAWAO
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State | HI
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Zip | 96768-7503
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Country | US
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Telephone | 808-205-8055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | MAKAWAO
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State | HI
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Zip | 96768-0458
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Country | US
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Telephone | 808-205-8055
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | TERI HOLTER
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Credential | LCSW
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Telephone | 808-205-8055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LCSW3180
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License Number State | HI
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