Individual
GLEN WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
86-226 FARRINGTON HIGHWAY, WAIANAE, HI 96792-3128
(808) 696-4211
(808) 696-5516
Mailing address
86-226 FARRINGTON HWY, WAIANAE, HI 96792-3128
(808) 696-4211
(808) 696-5516
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000596742
HMSA QUEST
HI
Enumeration date
11/29/2006
Last updated
07/08/2007
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