Healthcare Provider Details

I. General information

NPI: 1083116388
Provider Name (Legal Business Name): BRIELLE ROSE HOFFER LSW, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 KULL RD
LANCASTER OH
43130
US

IV. Provider business mailing address

1592 GRANVILLE PIKE
LANCASTER OH
43130-1076
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS.1600634
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: