Provider Demographics
NPI:1659734507
Name:BLEVINS, JOSEPH KEKOA
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KEKOA
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-1751 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2064
Mailing Address - Country:US
Mailing Address - Phone:808-821-4480
Mailing Address - Fax:808-821-4483
Practice Address - Street 1:4-1751 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2064
Practice Address - Country:US
Practice Address - Phone:808-821-4480
Practice Address - Fax:808-821-4483
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker