Provider Demographics
NPI:1962779934
Name:DEPT. OF HEALTH-HAWAII-CHILD AND ADOLESCENT MENTAL HEALTH DIVISION
Entity type:Organization
Organization Name:DEPT. OF HEALTH-HAWAII-CHILD AND ADOLESCENT MENTAL HEALTH DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:M.
Authorized Official - Middle Name:STANTON
Authorized Official - Last Name:MICHELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-733-9339
Mailing Address - Street 1:3627 KILAUEA AVE
Mailing Address - Street 2:ROOM 101-ATTN: PHAO
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2317
Mailing Address - Country:US
Mailing Address - Phone:808-733-4198
Mailing Address - Fax:808-733-8375
Practice Address - Street 1:270 WAIEHU BEACH RD
Practice Address - Street 2:UNIT 213-MAUI FGC-WAILUKU
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1472
Practice Address - Country:US
Practice Address - Phone:808-243-1252
Practice Address - Fax:808-243-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health