Provider Demographics
NPI:1104073113
Name:WAIAU, CORNELIA C (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CORNELIA
Middle Name:C
Last Name:WAIAU
Suffix:
Gender:F
Credentials:LMFT
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 10703
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-5703
Mailing Address - Country:US
Mailing Address - Phone:808-938-6842
Mailing Address - Fax:
Practice Address - Street 1:101 AUPUNI ST STE 241
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4261
Practice Address - Country:US
Practice Address - Phone:808-938-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT - 378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist