Provider Demographics
NPI:1770046674
Name:ANNANDALE, NEIL O (PHD, CGP)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:O
Last Name:ANNANDALE
Suffix:
Gender:M
Credentials:PHD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 804
Mailing Address - Street 2:
Mailing Address - City:HAUULA
Mailing Address - State:HI
Mailing Address - Zip Code:96717
Mailing Address - Country:US
Mailing Address - Phone:808-429-5504
Mailing Address - Fax:
Practice Address - Street 1:54-242B HONOMU STREET
Practice Address - Street 2:
Practice Address - City:HAUULA
Practice Address - State:HI
Practice Address - Zip Code:96717
Practice Address - Country:US
Practice Address - Phone:808-429-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1202103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling