Provider Demographics
NPI:1548880255
Name:STILWELL, LISA (LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STILWELL
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S KIHEI RD
Mailing Address - Street 2:STE O, PMB 126
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8200
Mailing Address - Country:US
Mailing Address - Phone:808-793-4536
Mailing Address - Fax:
Practice Address - Street 1:14 LAUMAKANI LOOP
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8200
Practice Address - Country:US
Practice Address - Phone:808-793-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA605769971041C0700X
HI41091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical