Healthcare Provider Details

I. General information

NPI: 1679410179
Provider Name (Legal Business Name): JUSTIN BOLLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 COYNE ST
HONOLULU HI
96826-1331
US

IV. Provider business mailing address

1950 COYNE ST
HONOLULU HI
96826-1331
US

V. Phone/Fax

Practice location:
  • Phone: 808-888-9984
  • Fax: 808-888-9984
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: