Provider Demographics
NPI:1104340868
Name:HATAE, MYCHAL CHIYOKO KANOURA (LCSW)
Entity type:Individual
Prefix:
First Name:MYCHAL
Middle Name:CHIYOKO KANOURA
Last Name:HATAE
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 1:3015 WOOLSEY PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1567
Mailing Address - Country:US
Mailing Address - Phone:808-292-2465
Mailing Address - Fax:
Practice Address - Street 1:3015 WOOLSEY PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1567
Practice Address - Country:US
Practice Address - Phone:808-292-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:2017-10-18
Deactivation Code:
Reactivation Date:2020-10-07
Provider Licenses
StateLicense IDTaxonomies
HI40451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical