Provider Demographics
NPI:1316007610
Name:KINIMAKA, TERI-ANN (LCSW, CSAC,CCJP, SAP)
Entity Type:Individual
Prefix:
First Name:TERI-ANN
Middle Name:
Last Name:KINIMAKA
Suffix:
Gender:F
Credentials:LCSW, CSAC,CCJP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ALEWA DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1533
Mailing Address - Country:US
Mailing Address - Phone:808-392-4813
Mailing Address - Fax:808-590-2328
Practice Address - Street 1:750 ALEWA DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1533
Practice Address - Country:US
Practice Address - Phone:808-392-4813
Practice Address - Fax:808-590-2328
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HICCDP-D 110-11101YA0400X
HISAP - 20478101YA0400X
HICCJP 330-11101YA0400X
HICSAC 1687-12101YA0400X
HILCSW-33831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI627119Medicaid