Provider Demographics
NPI:1154774024
Name:VASSEY, MINA
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:VASSEY
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 1:91-2128 OLD FT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1911
Mailing Address - Country:US
Mailing Address - Phone:808-738-6814
Mailing Address - Fax:085-892-6108
Practice Address - Street 1:91-2128 OLD FT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1911
Practice Address - Country:US
Practice Address - Phone:808-738-6814
Practice Address - Fax:085-892-6108
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-869101YM0800X
HI101YM0800X
101YM0800X
WA60902065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health