Provider Demographics
NPI:1043646938
Name:TAVARES, VICHELE A (LMHC)
Entity type:Individual
Prefix:
First Name:VICHELE
Middle Name:A
Last Name:TAVARES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CALIFORNIA AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1841
Mailing Address - Country:US
Mailing Address - Phone:808-478-3960
Mailing Address - Fax:
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-478-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMHC-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health