Provider Demographics
NPI:1205168549
Name:JOHN C. DONKERVOET, PH.D., LLC
Entity type:Organization
Organization Name:JOHN C. DONKERVOET, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CORNELIUS
Authorized Official - Last Name:DONKERVOET
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-371-5539
Mailing Address - Street 1:46-001 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 409
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3711
Mailing Address - Country:US
Mailing Address - Phone:808-371-5539
Mailing Address - Fax:808-247-4696
Practice Address - Street 1:46-001 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 409
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3711
Practice Address - Country:US
Practice Address - Phone:808-371-5539
Practice Address - Fax:808-247-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty