Provider Demographics
NPI:1205216959
Name:DSM THERAPEUTIC AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:DSM THERAPEUTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEDEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:MSCP
Authorized Official - Phone:808-387-3922
Mailing Address - Street 1:92-7045 KAHEA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2302
Mailing Address - Country:US
Mailing Address - Phone:808-387-3922
Mailing Address - Fax:808-672-0104
Practice Address - Street 1:91-1100 PAAOLOULU WAY
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3102
Practice Address - Country:US
Practice Address - Phone:808-387-3922
Practice Address - Fax:808-672-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103TC1900X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty