Provider Demographics
NPI:1669743720
Name:HO, KRISTINE (LSW, ACSW)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:LSW, ACSW
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:OTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 UAU PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8269
Mailing Address - Country:US
Mailing Address - Phone:808-876-1460
Mailing Address - Fax:808-876-1460
Practice Address - Street 1:34 UAU PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8269
Practice Address - Country:US
Practice Address - Phone:808-276-9817
Practice Address - Fax:808-876-1460
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW 835104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker