| Doctor Name: | DR. JENNIFER L. DE COSTA |
| NPI Number: | 1063665529 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, MFT, CSAC |
| License Number: | 1249-05 |
| Business Practice Address: | 75-5751 Kuakini Hwy Suite 105 Kailua Kona, HI - 967401752 |
| Business Phone Number: | 8083265629 |
| Business Fax Number: | 8083295057 |
| Mailing Address: | 75-5751 Kuakini Hwy, Suite 105 KAILUA KONA |
| State: | HI |
| Postal Code: | 967401752 |
| Phone Number: | 8083265629 |
| Fax Number: | 8083295057 |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 04/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1249-05 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |