Provider Demographics
NPI:1831354398
Name:VAN LOON, JACQUELINE CAROL (LPC LICENSED PROFESS)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CAROL
Last Name:VAN LOON
Suffix:
Gender:F
Credentials:LPC LICENSED PROFESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SO BERETANIA ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826
Mailing Address - Country:US
Mailing Address - Phone:808-945-3690
Mailing Address - Fax:808-945-2811
Practice Address - Street 1:1500 SO BERETANIA ST
Practice Address - Street 2:SUITE 403
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826
Practice Address - Country:US
Practice Address - Phone:808-945-3690
Practice Address - Fax:808-945-2811
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional