Provider Demographics
NPI:1881995900
Name:CHAMBLISS-ALEXANDER, SONYA BETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:BETH
Last Name:CHAMBLISS-ALEXANDER
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 1:140 KAHANA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-8314
Mailing Address - Country:US
Mailing Address - Phone:808-250-9406
Mailing Address - Fax:808-442-1056
Practice Address - Street 1:10 HOOHUI RD
Practice Address - Street 2:STE 207
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-9256
Practice Address - Country:US
Practice Address - Phone:808-250-9405
Practice Address - Fax:808-442-1056
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-129271041C0700X
HI3861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical