Individual
ANNE MARIE PROVAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
75-127 LUNAPULE RD, SUITE 4A, KAILUA KONA, HI 96740-2119
(808) 640-6133
Mailing address
PO BOX 553, HONAUNAU, HI 96726-0553
(808) 640-6133
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
150
HI
Other
Enumeration date
10/26/2007
Last updated
08/23/2010
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