Provider Demographics
NPI:1538599170
Name:PETROPULOS, CHEVAUN BROOKS
Entity type:Individual
Prefix:MRS
First Name:CHEVAUN
Middle Name:BROOKS
Last Name:PETROPULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 N MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-3700
Mailing Address - Country:US
Mailing Address - Phone:808-344-7511
Mailing Address - Fax:808-244-2254
Practice Address - Street 1:81 N MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-3700
Practice Address - Country:US
Practice Address - Phone:808-344-7511
Practice Address - Fax:808-244-2254
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health