Provider Demographics
NPI:1720733017
Name:CHADWICK, CHRISTY R
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:R
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LUNA KIA PL
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-3519
Mailing Address - Country:US
Mailing Address - Phone:808-633-3759
Mailing Address - Fax:
Practice Address - Street 1:18 LUNA KIA PL
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-3519
Practice Address - Country:US
Practice Address - Phone:808-633-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
HIMFT-934106H00000X
ORR9559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist