Healthcare Provider Details

I. General information

NPI: 1477190338
Provider Name (Legal Business Name): REGINA HOFFMANN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 CHICKAMAUGA DR
HARPERS FERRY WV
25425-3633
US

IV. Provider business mailing address

769 CHICKAMAUGA DR
HARPERS FERRY WV
25425-3633
US

V. Phone/Fax

Practice location:
  • Phone: 540-272-1129
  • Fax:
Mailing address:
  • Phone: 540-272-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00945609
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: