Provider Demographics
NPI:1215159561
Name:GEORGENS, GLENDA L (MHC, NCC)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:L
Last Name:GEORGENS
Suffix:
Gender:F
Credentials:MHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 IKENA KAI PLACE
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790
Mailing Address - Country:US
Mailing Address - Phone:808-214-3561
Mailing Address - Fax:808-787-3490
Practice Address - Street 1:125 W KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2237
Practice Address - Country:US
Practice Address - Phone:808-877-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health