Provider Demographics
NPI:1518105048
Name:SATO-SUGIMOTO, STACIE S (MHC, NCC, LBA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:S
Last Name:SATO-SUGIMOTO
Suffix:
Gender:F
Credentials:MHC, NCC, LBA, BCBA
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 26407
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-6407
Mailing Address - Country:US
Mailing Address - Phone:808-255-9459
Mailing Address - Fax:
Practice Address - Street 1:710 PALEKAUA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4755
Practice Address - Country:US
Practice Address - Phone:808-255-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI89101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health