Provider Demographics
NPI:1780834507
Name:MCNICOLL, EYDIEDARNELL (LMHC)
Entity type:Individual
Prefix:
First Name:EYDIEDARNELL
Middle Name:
Last Name:MCNICOLL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1029 KAHANALEI ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3246
Mailing Address - Country:US
Mailing Address - Phone:808-222-2086
Mailing Address - Fax:
Practice Address - Street 1:91-1029 KAHANALEI ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3246
Practice Address - Country:US
Practice Address - Phone:808-222-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
HIMHC-500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling