Provider Demographics
NPI:1063756294
Name:WYANT, LUISA C O (LCSW)
Entity type:Individual
Prefix:MS
First Name:LUISA
Middle Name:C O
Last Name:WYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 HAHAIONE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1030
Mailing Address - Country:US
Mailing Address - Phone:808-753-2547
Mailing Address - Fax:
Practice Address - Street 1:747 HAHAIONE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1030
Practice Address - Country:US
Practice Address - Phone:808-753-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical