Provider Demographics
NPI:1346447976
Name:CENTER FOR INTEGRATIVE THERAPY
Entity type:Organization
Organization Name:CENTER FOR INTEGRATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-329-7176
Mailing Address - Street 1:PO BOX 4938
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-4938
Mailing Address - Country:US
Mailing Address - Phone:808-329-7176
Mailing Address - Fax:808-326-1279
Practice Address - Street 1:77-6425 KUAKINI HWY
Practice Address - Street 2:SUITE D-102
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3213
Practice Address - Country:US
Practice Address - Phone:808-329-7176
Practice Address - Fax:808-326-1279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOPHIA WANG & ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-28
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY1104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty