Provider Demographics
NPI:1124365572
Name:GANDALIRA, CAROLYN KAY
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KAY
Last Name:GANDALIRA
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 1:75-170 HUALALAI RD
Mailing Address - Street 2:B103
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1779
Mailing Address - Country:US
Mailing Address - Phone:808-589-1829
Mailing Address - Fax:808-589-2610
Practice Address - Street 1:75-170 HUALALAI RD
Practice Address - Street 2:B103
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1779
Practice Address - Country:US
Practice Address - Phone:808-589-1829
Practice Address - Fax:808-589-2610
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor