Provider Demographics
NPI:1093027195
Name:CUBAN, THAD ANALU (CSAC)
Entity Type:Individual
Prefix:MR
First Name:THAD
Middle Name:ANALU
Last Name:CUBAN
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 CORAL ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5135
Mailing Address - Country:US
Mailing Address - Phone:808-791-6177
Mailing Address - Fax:
Practice Address - Street 1:606 CORAL ST FL 3
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5135
Practice Address - Country:US
Practice Address - Phone:808-791-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1321 - 07101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)