Healthcare Provider Details

I. General information

NPI: 1922816073
Provider Name (Legal Business Name): JAMES DAVID HOFFMAN SUDP-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CONTINENTAL PL
MOUNT VERNON WA
98273-5633
US

IV. Provider business mailing address

1905 CONTINENTAL PL
MOUNT VERNON WA
98273-5633
US

V. Phone/Fax

Practice location:
  • Phone: 360-755-6400
  • Fax: 360-755-6407
Mailing address:
  • Phone: 360-755-6400
  • Fax: 360-755-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC61585018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: