Provider Demographics
NPI:1932642857
Name:CHIN, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-656 HANILE ST
Mailing Address - Street 2:D-104
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4621
Mailing Address - Country:US
Mailing Address - Phone:617-899-6063
Mailing Address - Fax:
Practice Address - Street 1:95-656 HANILE ST
Practice Address - Street 2:D-104
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-4621
Practice Address - Country:US
Practice Address - Phone:617-899-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-25
Last Update Date:2020-05-14
Deactivation Date:2018-03-06
Deactivation Code:
Reactivation Date:2020-05-14
Provider Licenses
StateLicense IDTaxonomies
HI1761-13101YA0400X
HIMHC-359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)