Provider Demographics
NPI:1952805186
Name:SAKURA CENTER FOR PSYCHOLOGICAL ASSESSMENT AND THERAPY
Entity Type:Organization
Organization Name:SAKURA CENTER FOR PSYCHOLOGICAL ASSESSMENT AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-469-6377
Mailing Address - Street 1:91-1010 SHANGRILA ST STE 307
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91-1010 SHANGRILA ST STE 307
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2176
Practice Address - Country:US
Practice Address - Phone:808-469-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty