Provider Demographics
NPI:1639213135
Name:AIYANA, KELLEY (LCSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:AIYANA
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:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-1960
Mailing Address - Country:US
Mailing Address - Phone:808-281-8948
Mailing Address - Fax:808-214-5027
Practice Address - Street 1:1847 S KIHEI RD
Practice Address - Street 2:SUITE 205
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7931
Practice Address - Country:US
Practice Address - Phone:808-281-8948
Practice Address - Fax:808-214-5027
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-31941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical