Provider Demographics
NPI:1891077343
Name:ALCISTO, ALEXANDRA LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LEIGH
Last Name:ALCISTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:LEIGH
Other - Last Name:ALCISTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25-3535 OPALIPALI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1373
Mailing Address - Country:US
Mailing Address - Phone:808-747-4353
Mailing Address - Fax:
Practice Address - Street 1:234 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2418
Practice Address - Country:US
Practice Address - Phone:808-747-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health