Provider Demographics
NPI:1699080390
Name:REVILLA, SHEREE D (MFT, CSAC, CADC)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:D
Last Name:REVILLA
Suffix:
Gender:F
Credentials:MFT, CSAC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 1306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3801
Mailing Address - Country:US
Mailing Address - Phone:808-284-4104
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU ST
Practice Address - Street 2:SUITE 412
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2528
Practice Address - Country:US
Practice Address - Phone:808-284-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1434-09101YA0400X
HI253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)