Provider Demographics
NPI:1720295678
Name:WATERS, CHRISTINE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 KAMEHAMEHA AVE
Mailing Address - Street 2:A-7
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4678
Mailing Address - Country:US
Mailing Address - Phone:808-934-9773
Mailing Address - Fax:808-934-9774
Practice Address - Street 1:1266 KAMEHAMEHA AVE
Practice Address - Street 2:A-7
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4678
Practice Address - Country:US
Practice Address - Phone:808-934-9773
Practice Address - Fax:808-934-9774
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist