Provider Demographics
NPI:1811144488
Name:BACON, DION MARCEL (MS PSYCHOLOGY)
Entity type:Individual
Prefix:MR
First Name:DION
Middle Name:MARCEL
Last Name:BACON
Suffix:
Gender:M
Credentials:MS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1455 HOOHIKI ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2308
Mailing Address - Country:US
Mailing Address - Phone:808-330-3490
Mailing Address - Fax:
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-596-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH00561509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health