Provider Demographics
NPI:1114631629
Name:DEEDS, KEVIN (SAC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DEEDS
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78-1043 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:HOLUALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96725-9713
Mailing Address - Country:US
Mailing Address - Phone:808-339-2910
Mailing Address - Fax:
Practice Address - Street 1:75-170 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1779
Practice Address - Country:US
Practice Address - Phone:808-895-0148
Practice Address - Fax:808-664-6721
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI231284OtherNAADAC