Provider Demographics
NPI:1790022739
Name:MORTENSEN, DAYNA CARMEN (MHC)
Entity Type:Individual
Prefix:
First Name:DAYNA CARMEN
Middle Name:
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-470 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4373
Mailing Address - Country:US
Mailing Address - Phone:808-294-8992
Mailing Address - Fax:
Practice Address - Street 1:42-470 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4373
Practice Address - Country:US
Practice Address - Phone:808-294-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health