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General NPI Number Information
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NPI Number | 1699080390
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Entity Type | Individual
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Provider Name | SHEREE D REVILLA MFT, CSAC, CADC
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Gender | Female
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 07/07/2012
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Provider Practice Location Address
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Address Line | 354 ULUNIU ST SUITE 412
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City | KAILUA
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State | HI
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Zip | 96734-2528
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Country | US
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Telephone | 808-284-4104
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 KAPIOLANI BLVD SUITE 1306
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City | HONOLULU
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State | HI
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Zip | 96814-3801
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Country | US
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Telephone | 808-284-4104
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1434-09
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License Number State | HI
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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 | 253
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License Number State | HI
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