Provider Demographics
NPI:1679066732
Name:DANIELS, STEPHANIE GRACE (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GRACE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73-4530 MAMALAHOA HWY
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9198
Mailing Address - Country:US
Mailing Address - Phone:808-938-1900
Mailing Address - Fax:
Practice Address - Street 1:73-4530 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9198
Practice Address - Country:US
Practice Address - Phone:808-938-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist