Healthcare Provider Details

I. General information

NPI: 1487778163
Provider Name (Legal Business Name): ELISSA JANE HOFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CROSSWINDS DR YOUTH ACADEMY, LLC
FAIRMONT WV
26554-9193
US

IV. Provider business mailing address

95 MARION ST
MORGANTOWN WV
26505-5667
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-3341
  • Fax: 304-363-3342
Mailing address:
  • Phone: 304-284-8955
  • Fax: 304-284-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17983
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number17983
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: