Provider Demographics
NPI:1851441257
Name:ISLAND COUNSELING AFFILIATES, LLC
Entity Type:Organization
Organization Name:ISLAND COUNSELING AFFILIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-326-7653
Mailing Address - Street 1:76-6300 MAHUAHUA PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2224
Mailing Address - Country:US
Mailing Address - Phone:808-326-7653
Mailing Address - Fax:808-329-0188
Practice Address - Street 1:76-6300 MAHUAHUA PL
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2224
Practice Address - Country:US
Practice Address - Phone:808-326-7653
Practice Address - Fax:808-329-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty