=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821242827
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA RHONDA JO HOFFPAUIR LCDC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2008
-----------------------------------------------------
Last Update Date | 11/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 413 MCKINNEY ST APT. #4
-----------------------------------------------------
City | WINNSBORO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75494-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-342-6921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 413 MCKINNEY ST APT. #4
-----------------------------------------------------
City | WINNSBORO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75494-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-342-6921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 10439
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 100681 TEMPORARY
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------