Provider Demographics
NPI:1992840987
Name:LECKIE, DAE HELENA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DAE
Middle Name:HELENA
Last Name:LECKIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LILIUOKALANI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8633
Mailing Address - Country:US
Mailing Address - Phone:808-573-6937
Mailing Address - Fax:808-573-6937
Practice Address - Street 1:324 LILIUOKALANI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8633
Practice Address - Country:US
Practice Address - Phone:808-573-6937
Practice Address - Fax:808-573-6937
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS104581041C0700X
HI32511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000259440OtherHMSA PROVIDER NUMBER