Provider Demographics
NPI:1194261230
Name:FENTON, TREY HALLIDAY (LCSW, CSAC, LLC)
Entity type:Individual
Prefix:MR
First Name:TREY
Middle Name:HALLIDAY
Last Name:FENTON
Suffix:
Gender:M
Credentials:LCSW, CSAC, LLC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:HALLIDAY
Other - Last Name:FENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2406 PUUNOA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3419
Mailing Address - Country:US
Mailing Address - Phone:808-542-1389
Mailing Address - Fax:
Practice Address - Street 1:2406 PUUNOA PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3419
Practice Address - Country:US
Practice Address - Phone:808-542-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 41921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical