Basic Information
| Provider Information | |||||||||
| NPI: | 1184009268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AFONG | ||||||||
| FirstName: | MEGHAN-FAITH | ||||||||
| MiddleName: | TAGAMA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TAGAMA | ||||||||
| OtherFirstName: | MEGHAN-FAITH | ||||||||
| OtherMiddleName: | BRITTANY | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 268 | ||||||||
| Address2: | |||||||||
| City: | KEKAHA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967520268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083417414 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3-3122 KUHIO HWY | ||||||||
| Address2: | A-15 | ||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082469102 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2015 | ||||||||
| LastUpdateDate: | 07/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.