Healthcare Provider Details

I. General information

NPI: 1902563851
Provider Name (Legal Business Name): ALEXANDRIA WOMACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 CITRON ST APT 803
HONOLULU HI
96826-3560
US

IV. Provider business mailing address

2222 CITRON ST APT 803
HONOLULU HI
96826-3560
US

V. Phone/Fax

Practice location:
  • Phone: 808-798-9398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-1043-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: