Organization
ILLUMINATE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAUREN E AMPOLOS PHD (MEMBER)
(808) 518-1619
Entity
Organization
Contact information
Practice address
151 E WAKEA AVE, KAHULUI, HI 96732-2475
(808) 518-1619
(844) 587-9577
Mailing address
415 DAIRY RD STE E323, KAHULUI, HI 96732-2348
(808) 518-1619
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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