Provider Demographics
NPI:1376966804
Name:SULLA, PAUL JOSEPH III (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:SULLA
Suffix:III
Gender:M
Credentials:MA, MFT
Other - Prefix:MR
Other - First Name:P.
Other - Middle Name:JOSEPH
Other - Last Name:SULLA
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:PO BOX 1514
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-1514
Mailing Address - Country:US
Mailing Address - Phone:808-937-7323
Mailing Address - Fax:
Practice Address - Street 1:622 HINANO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4427
Practice Address - Country:US
Practice Address - Phone:808-969-1935
Practice Address - Fax:808-969-3276
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist