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General NPI Number Information
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NPI Number | 1962832592
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Entity Type | Organization
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Legal Business Name | ALOHA OCEAN CLINIC, LLC
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 91-1001 KAIMALIE ST STE 201B
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City | EWA BEACH
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State | HI
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Zip | 96706-6250
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Country | US
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Telephone | 808-230-5224
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Fax |
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Provider Business Mailing Address
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Address Line | 1979 AAMAKA PL
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City | PEARL CITY
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State | HI
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Zip | 96782-1302
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SIMONE OVERMAN-STARKMAN
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Credential | PSYD
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Telephone | 808-230-5224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1388
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License Number State | HI
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