Provider Demographics
NPI:1295118107
Name:RACINE, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:RACINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WARD AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4008
Mailing Address - Country:US
Mailing Address - Phone:808-380-4465
Mailing Address - Fax:808-380-3943
Practice Address - Street 1:210 WARD AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4008
Practice Address - Country:US
Practice Address - Phone:808-380-4465
Practice Address - Fax:808-380-3943
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst