Provider Demographics
NPI:1770812927
Name:ROBINSON, DIANE M (MFT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-980 PARADISE ALA KAI DR # A7
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-7120
Mailing Address - Country:US
Mailing Address - Phone:808-443-1089
Mailing Address - Fax:
Practice Address - Street 1:308 KAMEHAMEHA AVE
Practice Address - Street 2:STE. 212
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2960
Practice Address - Country:US
Practice Address - Phone:808-443-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist