Individual
EMAN'ON FEARLESS WANDERER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1390 MILLER ST, HONOLULU, HI 96813-2493
(808) 784-6200
Mailing address
PO BOX 1841, MAKAWAO, HI 96768-1841
(808) 283-3016
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
HI
172V00000X
Community Health Worker
—
HI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
171M00000X
CA
Other
Enumeration date
12/27/2010
Last updated
11/20/2024
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