Provider Demographics
NPI:1568841690
Name:CYNTHIA FATA, LMHC, COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:CYNTHIA FATA, LMHC, COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FATA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:808-854-0436
Mailing Address - Street 1:614 KILAUEA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4272
Mailing Address - Country:US
Mailing Address - Phone:808-854-0436
Mailing Address - Fax:
Practice Address - Street 1:614 KILAUEA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4272
Practice Address - Country:US
Practice Address - Phone:808-854-0436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC 358251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health