Provider Demographics
NPI:1386846764
Name:HOFFMAN, ANGELA C (MA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-0328
Mailing Address - Country:US
Mailing Address - Phone:304-903-4774
Mailing Address - Fax:
Practice Address - Street 1:806 9TH AVE
Practice Address - Street 2:
Practice Address - City:MARLINTON
Practice Address - State:WV
Practice Address - Zip Code:24954-1308
Practice Address - Country:US
Practice Address - Phone:304-903-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1063103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3910003454Medicaid