Provider Demographics
NPI:1912421116
Name:SARGENT, TEAL LANI (LCSW)
Entity Type:Individual
Prefix:
First Name:TEAL
Middle Name:LANI
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-0366
Mailing Address - Country:US
Mailing Address - Phone:808-635-4371
Mailing Address - Fax:
Practice Address - Street 1:5-4280 KUHIO HWY STE G-210C
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:HI
Practice Address - Zip Code:96722-5451
Practice Address - Country:US
Practice Address - Phone:808-635-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI104100000X
HI47371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker