Provider Demographics
NPI:1902252547
Name:WAGNER, ROCHELLE SABRINA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:SABRINA
Last Name:WAGNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:SABRINA
Other - Last Name:DUARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 KILAUEA AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4272
Mailing Address - Country:US
Mailing Address - Phone:808-300-6198
Mailing Address - Fax:
Practice Address - Street 1:614 KILAUEA AVE STE 15
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4272
Practice Address - Country:US
Practice Address - Phone:808-300-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-810-0106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist