Provider Demographics
NPI:1578931168
Name:MARKS, MAITA DE LEON (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MAITA
Middle Name:DE LEON
Last Name:MARKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5984 GANNET AVE
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3239
Mailing Address - Country:US
Mailing Address - Phone:808-600-1132
Mailing Address - Fax:
Practice Address - Street 1:438 HOBRON LN
Practice Address - Street 2:SUITE 311
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815
Practice Address - Country:US
Practice Address - Phone:808-585-1424
Practice Address - Fax:808-585-0379
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-737106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist