Provider Demographics
NPI:1417379801
Name:WADDOUPS, NANI (LPC, MA, NCC)
Entity Type:Individual
Prefix:
First Name:NANI
Middle Name:
Last Name:WADDOUPS
Suffix:
Gender:F
Credentials:LPC, MA, NCC
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 174
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-0174
Mailing Address - Country:US
Mailing Address - Phone:503-784-6214
Mailing Address - Fax:
Practice Address - Street 1:45-3497 KOA RD
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727
Practice Address - Country:US
Practice Address - Phone:503-784-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health