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General NPI Number Information
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NPI Number | 1740319177
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Entity Type | Individual
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Provider Name | SUSAN C SICKORA CSAC
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 970 N KALAHEO AVE SUITE A102
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City | KAILUA
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State | HI
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Zip | 96734-1801
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Country | US
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Telephone | 808-254-6484
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Fax | 808-254-6427
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Provider Business Mailing Address
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Address Line | 820 MILILANI ST STE 702A
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City | HONOLULU
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State | HI
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Zip | 96813-2918
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Country | US
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Telephone | 808-523-9363
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Fax | 808-523-9418
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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 | RN26584
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License Number State | HI
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