Provider Demographics
NPI:1477898179
Name:MCWEENEY, MELIDA MYRA
Entity Type:Individual
Prefix:MRS
First Name:MELIDA
Middle Name:MYRA
Last Name:MCWEENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74-5088 PALANI RD # B
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8109
Mailing Address - Country:US
Mailing Address - Phone:808-987-5856
Mailing Address - Fax:
Practice Address - Street 1:74-5088 PALANI RD # B
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-8109
Practice Address - Country:US
Practice Address - Phone:808-987-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor