Provider Demographics
NPI:1427413707
Name:FAMILY AND ADDICTION COUNSELING, LLC
Entity type:Organization
Organization Name:FAMILY AND ADDICTION COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:CARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:412-342-8467
Mailing Address - Street 1:1888 KALAKAUA AVE STE C312
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1550
Mailing Address - Country:US
Mailing Address - Phone:412-342-8467
Mailing Address - Fax:
Practice Address - Street 1:1888 KALAKAUA AVE STE C312
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1550
Practice Address - Country:US
Practice Address - Phone:412-342-8467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty