Provider Demographics
NPI:1912372582
Name:SANDS, RACHAEL ANTONIO (BCABA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANTONIO
Last Name:SANDS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 ALA MAKANI ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3507
Mailing Address - Country:US
Mailing Address - Phone:808-244-6879
Mailing Address - Fax:808-873-0273
Practice Address - Street 1:2575 ALA OLU PL
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5079
Practice Address - Country:US
Practice Address - Phone:808-868-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-19-10279106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst