Provider Demographics
NPI:1659785913
Name:ADOLPHO, KESHIA (LCSW)
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:
Last Name:ADOLPHO
Suffix:
Gender:F
Credentials:LCSW
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 1464
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-1464
Mailing Address - Country:US
Mailing Address - Phone:808-658-1417
Mailing Address - Fax:866-461-6786
Practice Address - Street 1:61 ALA MALAMA ST
Practice Address - Street 2:UNIT 4
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-658-1417
Practice Address - Fax:866-461-6786
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical