Healthcare Provider Details

I. General information

NPI: 1194334847
Provider Name (Legal Business Name): MICHELLE HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

368 FLORY HTS
CENTER RUTLAND VT
05736-9750
US

V. Phone/Fax

Practice location:
  • Phone: 802-353-9335
  • Fax:
Mailing address:
  • Phone: 802-353-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134243
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: