Individual
JACK CRUZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW CSAC
Contact information
Practice address
81-6587 MAMALAHOA HWY, SUITE C-203, KEALAKEKUA, HI 96750
(808) 987-2451
Mailing address
PO BOX 928, CAPTAIN COOK, HI 96704-0928
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1663-12
HI
1041C0700X
Clinical Social Worker
Primary
3904
HI
Other
Enumeration date
05/05/2014
Last updated
05/05/2014
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