Provider Demographics
NPI:1225548365
Name:LAZENBY, ALICIA NOEL
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:NOEL
Last Name:LAZENBY
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 1:16-566 KEAAU PAHOA RD STE 188-805
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11-2484 KALEPONI DR.
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:HI
Practice Address - Zip Code:96785
Practice Address - Country:US
Practice Address - Phone:551-252-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker