Individual
DR. JENNIFER L. DE COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, MFT, CSAC
Contact information
Practice address
75-5751 KUAKINI HWY, SUITE 105, KAILUA KONA, HI 96740-1752
(808) 326-5629
(808) 329-5057
Mailing address
75-5751 KUAKINI HWY, SUITE 105, KAILUA KONA, HI 96740-1752
(808) 326-5629
(808) 329-5057
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1249-05
HI
106H00000X
Marriage & Family Therapist
Primary
MFT272
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1249-05
CSAC
HI
01
—
MFT272
MFT
HI
Enumeration date
10/28/2008
Last updated
04/06/2011
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