Provider Demographics
NPI:1235027558
Name:TANUVASA, CARLINE M
Entity type:Individual
Prefix:
First Name:CARLINE
Middle Name:M
Last Name:TANUVASA
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 1:91-1295 HOOPIO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1991
Mailing Address - Country:US
Mailing Address - Phone:808-721-5779
Mailing Address - Fax:
Practice Address - Street 1:91-1295 HOOPIO ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1991
Practice Address - Country:US
Practice Address - Phone:808-721-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI39-2678108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health