Provider Demographics
NPI:1104500552
Name:PACIFIC SHORES PSYCHOLOGY LLC
Entity type:Organization
Organization Name:PACIFIC SHORES PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ROLLINS
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-444-5944
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 1114
Mailing Address - Street 2:UNIT 79599
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4406
Mailing Address - Country:US
Mailing Address - Phone:808-444-5944
Mailing Address - Fax:
Practice Address - Street 1:401 KAMAKEE ST
Practice Address - Street 2:SUITE #405
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-444-5944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty