Individual
DR. TRACEY WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28-2890 KAPEHU PLACE, PEPEEKEO, HI 96783
(808) 895-2593
Mailing address
PO BOX 1022, PEPEEKEO, HI 96783-1022
(808) 895-2593
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1414-08
HI
101YM0800X
Mental Health Counselor
Primary
MHC-253
HI
Other
Enumeration date
10/13/2022
Last updated
10/13/2022
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