Provider Demographics
NPI:1093551756
Name:HUSTACE, CHRISTINE CECILE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CECILE
Last Name:HUSTACE
Suffix:
Gender:F
Credentials:
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 198900
Mailing Address - Street 2:PMB 234
Mailing Address - City:HAWI
Mailing Address - State:HI
Mailing Address - Zip Code:96719
Mailing Address - Country:US
Mailing Address - Phone:808-987-6288
Mailing Address - Fax:
Practice Address - Street 1:88 KANOELEHUA AVE STE B107
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4685
Practice Address - Country:US
Practice Address - Phone:808-933-0610
Practice Address - Fax:808-933-0558
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health