Provider Demographics
NPI:1932308111
Name:BOKUNIEWICZ, ALYSHA MARIE
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:MARIE
Last Name:BOKUNIEWICZ
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 1:7170 DAVENPORT RD
Mailing Address - Street 2:#109
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2955
Mailing Address - Country:US
Mailing Address - Phone:805-448-1113
Mailing Address - Fax:
Practice Address - Street 1:7170 DAVENPORT RD
Practice Address - Street 2:#109
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2955
Practice Address - Country:US
Practice Address - Phone:805-448-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health