Healthcare Provider Details

I. General information

NPI: 1922887587
Provider Name (Legal Business Name): LISA DIONNE HOFFMAN LMHC, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8102 CLEARVISTA PKWY
INDIANAPOLIS IN
46256-1661
US

IV. Provider business mailing address

8102 CLEARVISTA PKWY
INDIANAPOLIS IN
46256-1661
US

V. Phone/Fax

Practice location:
  • Phone: 317-572-9396
  • Fax: 317-579-7094
Mailing address:
  • Phone: 317-572-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000700A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002535A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: