Provider Demographics
NPI:1730438623
Name:VIDINHA, HARRISON JR
Entity type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:
Last Name:VIDINHA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:KURTISTOWN
Mailing Address - State:HI
Mailing Address - Zip Code:96760
Mailing Address - Country:US
Mailing Address - Phone:808-315-4367
Mailing Address - Fax:
Practice Address - Street 1:16 1107 UAU RD
Practice Address - Street 2:
Practice Address - City:KURTISTOWN
Practice Address - State:HI
Practice Address - Zip Code:96760
Practice Address - Country:US
Practice Address - Phone:808-315-4367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH00339928101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor