Provider Demographics
NPI:1063272573
Name:AGPAOA-THOMPSON, BRANDON AVERY
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:AVERY
Last Name:AGPAOA-THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 S OAHU ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2713
Mailing Address - Country:US
Mailing Address - Phone:808-344-8527
Mailing Address - Fax:
Practice Address - Street 1:270 HOOKAHI STREET # 210
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-344-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker