Provider Demographics
NPI:1366872111
Name:KEKAULIKE, KANIALA (PSYD)
Entity type:Individual
Prefix:DR
First Name:KANIALA
Middle Name:
Last Name:KEKAULIKE
Suffix:
Gender:M
Credentials:PSYD
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 5004
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-9004
Mailing Address - Country:US
Mailing Address - Phone:808-725-7351
Mailing Address - Fax:
Practice Address - Street 1:46-269 KAHUHIPA ST APT D207
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-6018
Practice Address - Country:US
Practice Address - Phone:808-725-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health