Healthcare Provider Details

I. General information

NPI: 1609301860
Provider Name (Legal Business Name): MALAKAI HOFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7613 STANDISH PL
ROCKVILLE MD
20855-2702
US

IV. Provider business mailing address

7617 FONTAINE ST
POTOMAC MD
20854-3302
US

V. Phone/Fax

Practice location:
  • Phone: 240-672-0436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: