Provider Demographics
NPI:1538931688
Name:KIRSTEN WONG
Entity type:Organization
Organization Name:KIRSTEN WONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:808-443-1467
Mailing Address - Street 1:150 KIMOKIMO PL
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-6053
Mailing Address - Country:US
Mailing Address - Phone:808-443-1467
Mailing Address - Fax:
Practice Address - Street 1:187847 KOLIKA ROAD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:HI
Practice Address - Zip Code:96771-9677
Practice Address - Country:US
Practice Address - Phone:808-494-9442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty