Provider Demographics
NPI:1033999230
Name:KELLEY HOFFER, PSYD LLC
Entity Type:Organization
Organization Name:KELLEY HOFFER, PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:803-761-7327
Mailing Address - Street 1:933 PINE LOG RD # 1072
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7330
Mailing Address - Country:US
Mailing Address - Phone:803-761-7327
Mailing Address - Fax:
Practice Address - Street 1:933 PINE LOG RD # 1072
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7330
Practice Address - Country:US
Practice Address - Phone:803-761-7327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1578218004Medicaid