Healthcare Provider Details

I. General information

NPI: 1578218004
Provider Name (Legal Business Name): KELLEY HOFFER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 OTTO RUN
NORTH AUGUSTA SC
29860-7730
US

IV. Provider business mailing address

2201 PERRINS LN
GROVETOWN GA
30813-0467
US

V. Phone/Fax

Practice location:
  • Phone: 706-231-7634
  • Fax:
Mailing address:
  • Phone: 803-761-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1708
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: