Provider Demographics
NPI:1649796194
Name:LIVING LIGHTHOUSE COUNSELING SERVICES
Entity type:Organization
Organization Name:LIVING LIGHTHOUSE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNI
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CARDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:808-652-9371
Mailing Address - Street 1:PO BOX 223492
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:HI
Mailing Address - Zip Code:96722-3492
Mailing Address - Country:US
Mailing Address - Phone:808-652-9371
Mailing Address - Fax:
Practice Address - Street 1:1470 WANAAO RD UNIT D
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2628
Practice Address - Country:US
Practice Address - Phone:808-652-9371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty