Provider Demographics
NPI:1063765311
Name:KEKUAWELA, DARISSA MK (LMHC)
Entity type:Individual
Prefix:
First Name:DARISSA
Middle Name:MK
Last Name:KEKUAWELA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1422
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-1422
Mailing Address - Country:US
Mailing Address - Phone:808-345-3307
Mailing Address - Fax:
Practice Address - Street 1:101 AUPUNI ST STE 118
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4260
Practice Address - Country:US
Practice Address - Phone:808-345-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health