Provider Demographics
NPI:1427184787
Name:ANDERSON, JOHN H (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 HEHI RD
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-9129
Mailing Address - Country:US
Mailing Address - Phone:808-635-2880
Mailing Address - Fax:808-632-2101
Practice Address - Street 1:3146 AKAHI ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1105
Practice Address - Country:US
Practice Address - Phone:808-635-2880
Practice Address - Fax:808-632-2101
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 32791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical