Healthcare Provider Details

I. General information

NPI: 1932887882
Provider Name (Legal Business Name): SILAS ROBERT LEE HOFFMAN MSW; LCSW-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. SILAS R. LEE HOFFMAN JR.

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 PIKES PEAK DR
GASTONIA NC
28052-5434
US

IV. Provider business mailing address

3455 PIKES PEAK DR
GASTONIA NC
28052-5434
US

V. Phone/Fax

Practice location:
  • Phone: 704-524-0952
  • Fax:
Mailing address:
  • Phone: 704-524-0952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016943
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: