Provider Demographics
NPI:1003479478
Name:DAVIS, NINA (LCSW,CSAC)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW,CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 POIPU DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2128
Mailing Address - Country:US
Mailing Address - Phone:808-428-4871
Mailing Address - Fax:
Practice Address - Street 1:875 WAIMANU ST STE 600
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5267
Practice Address - Country:US
Practice Address - Phone:808-389-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI44281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical