Healthcare Provider Details

I. General information

NPI: 1326100520
Provider Name (Legal Business Name): ROCHELLE MIA HOFFMAN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 LANDMARK DR
TAYLORS SC
29687-2819
US

IV. Provider business mailing address

161 LANDMARK DR
TAYLORS SC
29687-2819
US

V. Phone/Fax

Practice location:
  • Phone: 864-244-0154
  • Fax: 864-609-5003
Mailing address:
  • Phone: 864-244-0154
  • Fax: 864-609-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8536
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: