Provider Demographics
NPI:1023377033
Name:DRAKE, ASHLEY REBECCA GILLILAND (LBSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REBECCA GILLILAND
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 KILAUEA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3084
Mailing Address - Country:US
Mailing Address - Phone:808-935-3481
Mailing Address - Fax:
Practice Address - Street 1:460 KILAUEA AVE STE 101
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3084
Practice Address - Country:US
Practice Address - Phone:808-935-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2017104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker