Provider Demographics
NPI:1043284623
Name:HOFFMAN, JUDITH LYNN (MSW, LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9263-A MEDICAL PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-209-0961
Mailing Address - Fax:843-884-4019
Practice Address - Street 1:9263-A MEDICAL PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-209-0961
Practice Address - Fax:843-884-4019
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC721041C0700X
SC#72104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ348720281Medicare PIN