Provider Demographics
NPI:1902961840
Name:ACKLIN, MARVIN WILSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:WILSON
Last Name:ACKLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W. HIND DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1845
Mailing Address - Country:US
Mailing Address - Phone:808-373-3880
Mailing Address - Fax:808-373-1158
Practice Address - Street 1:850 W. HIND DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-373-3880
Practice Address - Fax:808-373-1158
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical