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General NPI Number Information
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NPI Number | 1922415280
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Entity Type | Organization
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Legal Business Name | PACIFIC WELLNESS, LLC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 401 KAMAKEE ST SUITE 417
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City | HONOLULU
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State | HI
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Zip | 96814-4203
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Country | US
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Telephone | 808-372-1952
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Fax |
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Provider Business Mailing Address
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Address Line | 401 KAMAKEE ST SUITE 417
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City | HONOLULU
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State | HI
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Zip | 96814-4203
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Country | US
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Telephone | 808-372-1952
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MELISSA HOGAN
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Credential | LMHC
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Telephone | 808-372-1952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 321
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License Number State | HI
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