Provider Demographics
NPI:1629559620
Name:ACOBA, KAYLA-JO
Entity Type:Individual
Prefix:
First Name:KAYLA-JO
Middle Name:
Last Name:ACOBA
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:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:HI
Mailing Address - Zip Code:96785-0772
Mailing Address - Country:US
Mailing Address - Phone:808-683-6068
Mailing Address - Fax:
Practice Address - Street 1:19-3927 KILINOE STREET
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:HI
Practice Address - Zip Code:96785
Practice Address - Country:US
Practice Address - Phone:877-584-6227
Practice Address - Fax:808-356-1310
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVILLAKA025RW106S00000X
HI680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician