Healthcare Provider Details

I. General information

NPI: 1750331989
Provider Name (Legal Business Name): JOHN CONRAD GROPPENBACHER CSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD 116
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

2319 ALA WAI BLVD APT #102
HONOLULU HI
96815-2638
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-0662
  • Fax: 808-433-0395
Mailing address:
  • Phone: 808-433-0662
  • Fax: 808-433-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3256
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: