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General NPI Number Information
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NPI Number | 1972975670
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Entity Type | Organization
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Legal Business Name | CAROL S. BLUM, PHD
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 65-1206 MAMALAHOA HWY SUITE 2-205
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City | KAMUELA
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State | HI
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Zip | 96743-7303
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Country | US
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Telephone | 808-785-0715
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Fax |
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Provider Business Mailing Address
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Address Line | 65-1206 MAMALAHOA HWY SUITE 2-205
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City | KAMUELA
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State | HI
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Zip | 96743-7303
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Country | US
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Telephone | 808-785-0715
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROL S BLUM
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Credential | PHD
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Telephone | 808-785-0715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1486
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License Number State | HI
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