Provider Demographics
NPI:1528779790
Name:WARRIOR OHANA THERAPY, LLC
Entity type:Organization
Organization Name:WARRIOR OHANA THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LCSW OWNER PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KANIAUPIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-222-2729
Mailing Address - Street 1:45-686 HALEMUKU WAY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3163
Mailing Address - Country:US
Mailing Address - Phone:808-222-2729
Mailing Address - Fax:
Practice Address - Street 1:45-955 KAMEHAMEHA HWY STE 401
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-222-2729
Practice Address - Fax:808-247-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI881674575Medicaid