Healthcare Provider Details

I. General information

NPI: 1194271205
Provider Name (Legal Business Name): NINA ELISA HOFFMAN M.A., MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NINA ELISA HOFFMAN M.A., MFTI

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MENDOCINO AVE
WILLITS CA
95490
US

IV. Provider business mailing address

PO BOX 2077
UKIAH CA
95482-2077
US

V. Phone/Fax

Practice location:
  • Phone: 707-459-6222
  • Fax:
Mailing address:
  • Phone: 707-467-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number77079
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF77079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: