Provider Demographics
NPI:1770827339
Name:PARK, CHERIE ANN M (LMHC)
Entity Type:Individual
Prefix:
First Name:CHERIE ANN
Middle Name:M
Last Name:PARK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PIIKOI ST
Mailing Address - Street 2:# 203
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3116
Mailing Address - Country:US
Mailing Address - Phone:808-589-1829
Mailing Address - Fax:
Practice Address - Street 1:91-1259 RENTON RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1936
Practice Address - Country:US
Practice Address - Phone:808-699-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI424101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor