Provider Demographics
NPI:1629636170
Name:RODRIGUES, ANTOINETTE M (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:M
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:35 HOLOMAKANI DRIVE
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-7953
Mailing Address - Country:US
Mailing Address - Phone:808-264-9392
Mailing Address - Fax:
Practice Address - Street 1:135 S. WAKEA AVENUE,
Practice Address - Street 2:SUITE 213
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1100
Practice Address - Country:US
Practice Address - Phone:808-866-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist