Provider Demographics
NPI:1316615776
Name:MANAGO, JEANETTE N (MSCP, NBCC, MHC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:N
Last Name:MANAGO
Suffix:
Gender:F
Credentials:MSCP, NBCC, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 MAGNOLIA PLACE
Mailing Address - Street 2:HONOLULU, HI 96816
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-382-6300
Mailing Address - Fax:
Practice Address - Street 1:98-940 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5011
Practice Address - Country:US
Practice Address - Phone:808-305-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health