Provider Demographics
NPI:1457896193
Name:MAKE A DIFFERENCE COUNSELING SERVICES
Entity Type:Organization
Organization Name:MAKE A DIFFERENCE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:FAUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSCP, LMHC, NCC
Authorized Official - Phone:808-206-0806
Mailing Address - Street 1:840 KAKALA ST APT 301
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4608
Mailing Address - Country:US
Mailing Address - Phone:808-206-0806
Mailing Address - Fax:
Practice Address - Street 1:840 KAKALA ST APT 301
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-4608
Practice Address - Country:US
Practice Address - Phone:808-206-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-420251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health