Healthcare Provider Details

I. General information

NPI: 1851442420
Provider Name (Legal Business Name): MELISSA HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E CHURCHVILLE RD
BEL AIR MD
21014-3442
US

IV. Provider business mailing address

1208 E CHURCHVILLE RD
BEL AIR MD
21014-3442
US

V. Phone/Fax

Practice location:
  • Phone: 800-305-2089
  • Fax:
Mailing address:
  • Phone: 800-305-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4616
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64776
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008656
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: