Provider Demographics
NPI:1386038842
Name:PARK, CHRISTINE (PHD, LMHC, NCC, CMP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:PHD, LMHC, NCC, CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-1312
Mailing Address - Country:US
Mailing Address - Phone:808-989-6905
Mailing Address - Fax:
Practice Address - Street 1:46-1016 EMEPELA WAY #22C
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3908
Practice Address - Country:US
Practice Address - Phone:808-541-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002080Medicaid