Provider Demographics
NPI:1972592343
Name:FONG, DARREN KC (MSW)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:KC
Last Name:FONG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-204 MOKULELE DR
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2336
Mailing Address - Country:US
Mailing Address - Phone:808-247-2990
Mailing Address - Fax:
Practice Address - Street 1:USAG-J, UNIT 45013, BOX 2063
Practice Address - Street 2:
Practice Address - City:KANEGAWA
Practice Address - State:YOKOHAMA
Practice Address - Zip Code:96338
Practice Address - Country:JP
Practice Address - Phone:01181311-763-4610
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP002566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health