Provider Demographics
NPI:1821523655
Name:TOWNSEND, NICKELINA
Entity Type:Individual
Prefix:
First Name:NICKELINA
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 MAKANI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3495
Mailing Address - Country:US
Mailing Address - Phone:541-561-5052
Mailing Address - Fax:
Practice Address - Street 1:1339 MAKANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3495
Practice Address - Country:US
Practice Address - Phone:541-561-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor