Provider Demographics
NPI:1578939468
Name:P. JOSEPH SULLA III, MFT, CSAC
Entity Type:Organization
Organization Name:P. JOSEPH SULLA III, MFT, CSAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT, CSAC
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SULLA
Authorized Official - Suffix:III
Authorized Official - Credentials:MFT, CSAC
Authorized Official - Phone:808-937-7323
Mailing Address - Street 1:PO BOX 1514
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-1514
Mailing Address - Country:US
Mailing Address - Phone:808-937-7323
Mailing Address - Fax:
Practice Address - Street 1:65-1106 MAMALAHOA HWY
Practice Address - Street 2:BLDG 2, ROOM 102
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743
Practice Address - Country:US
Practice Address - Phone:808-937-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty