Provider Demographics
NPI:1336805746
Name:LOFTIN, LORI (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LOFTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760
Mailing Address - Country:US
Mailing Address - Phone:808-854-6138
Mailing Address - Fax:
Practice Address - Street 1:16-1689 UAU ROAD
Practice Address - Street 2:
Practice Address - City:KURTISTOWN
Practice Address - State:HI
Practice Address - Zip Code:96760-9676
Practice Address - Country:US
Practice Address - Phone:808-854-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI27511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical