Basic Information
| Provider Information | |||||||||
| NPI: | 1619481140 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAHL | ||||||||
| FirstName: | SANTINA | ||||||||
| MiddleName: | APRIL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAYMOND | ||||||||
| OtherFirstName: | SANTINA | ||||||||
| OtherMiddleName: | APRIL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4876 ELIMA WAY APT A | ||||||||
| Address2: | |||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967063045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083580399 | ||||||||
| FaxNumber: | 8084330399 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 WAIMANU ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087916713 | ||||||||
| FaxNumber: | 8087916081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2017 | ||||||||
| LastUpdateDate: | 11/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.