Provider Demographics
NPI:1932746559
Name:DULLES, ALEXANDRA SOPHIA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:SOPHIA
Last Name:DULLES
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 1:34 MALIA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3745
Mailing Address - Country:US
Mailing Address - Phone:651-324-3284
Mailing Address - Fax:
Practice Address - Street 1:69 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7509
Practice Address - Country:US
Practice Address - Phone:808-935-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst