Provider Demographics
NPI:1134169840
Name:ASHLEY, DARLENE (PHD)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:ASHLEY
Other - Last Name:FAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:75-5744 ALII DR
Mailing Address - Street 2:STE 237
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1784
Mailing Address - Country:US
Mailing Address - Phone:808-329-5800
Mailing Address - Fax:808-329-4800
Practice Address - Street 1:75-5744 ALII DR
Practice Address - Street 2:STE 237
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1784
Practice Address - Country:US
Practice Address - Phone:808-329-5800
Practice Address - Fax:808-329-4800
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-386103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI026278Medicaid
HI026278Medicaid