Provider Demographics
NPI:1134501786
Name:LINKIN, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LINKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78-6649 ALII DR APT C
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-4471
Mailing Address - Country:US
Mailing Address - Phone:650-787-2281
Mailing Address - Fax:
Practice Address - Street 1:1045 KILAUEA AVE STE A
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4291
Practice Address - Country:US
Practice Address - Phone:650-787-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health