Provider Demographics
NPI:1376986067
Name:EBERT, RACHEL SAMANTHA DONAHUE (LCSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SAMANTHA DONAHUE
Last Name:EBERT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:SAMANTHA
Other - Last Name:DONAHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 N KUKUI ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3921
Mailing Address - Country:US
Mailing Address - Phone:808-672-2932
Mailing Address - Fax:
Practice Address - Street 1:245 N KUKUI ST STE 102A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3921
Practice Address - Country:US
Practice Address - Phone:808-672-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2030104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty