Doctor Name: | POE SUAAVA |
NPI Number: | 1013176353 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | |
Business Practice Address: | 85-979 Mill St Waianae, HI - 967922645 |
Business Phone Number: | 8086969498 |
Business Fax Number: | 8086969403 |
Mailing Address: | 86-226 Farrington Hwy, WAIANAE |
State: | HI |
Postal Code: | 967923128 |
Phone Number: | 8086964211 |
Fax Number: | 8086965516 |
NPI Enumeration Date: | 06/02/2008 |
NPI Last Update Date: | 06/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |