Provider Demographics
NPI:1376202218
Name:KUALOLI COUNSELING & PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:KUALOLI COUNSELING & PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-639-7255
Mailing Address - Street 1:PO BOX 1075
Mailing Address - Street 2:
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-1075
Mailing Address - Country:US
Mailing Address - Phone:808-639-7255
Mailing Address - Fax:
Practice Address - Street 1:5476 KOLOA ROAD, 2F
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-9675
Practice Address - Country:US
Practice Address - Phone:808-639-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty