Provider Demographics
NPI:1316263346
Name:LYONS, THERESA ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ELAINE
Last Name:LYONS
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 1:47-465 AIAI PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4817
Mailing Address - Country:US
Mailing Address - Phone:808-284-6501
Mailing Address - Fax:
Practice Address - Street 1:40 MALUNIU AVE
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-5810
Practice Address - Country:US
Practice Address - Phone:808-284-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI34871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical