Healthcare Provider Details

I. General information

NPI: 1265973937
Provider Name (Legal Business Name): RICHARD JOSEPH HOFFMANN SR. LICDC & LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 TIMBERCLIFF DR
MANSFIELD OH
44907-2930
US

IV. Provider business mailing address

1230 TIMBERCLIFF DR
MANSFIELD OH
44907-2930
US

V. Phone/Fax

Practice location:
  • Phone: 419-520-8850
  • Fax: 567-205-5060
Mailing address:
  • Phone: 419-520-8850
  • Fax: 567-205-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161969
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2002440
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: