Provider Demographics
NPI:1407020688
Name:HOFFMAN, ELLENDALE MCCOLLAM (DMIN)
Entity Type:Individual
Prefix:
First Name:ELLENDALE
Middle Name:MCCOLLAM
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SHARON LN
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2037
Mailing Address - Country:US
Mailing Address - Phone:860-388-3332
Mailing Address - Fax:
Practice Address - Street 1:8 SHARON LN
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2037
Practice Address - Country:US
Practice Address - Phone:860-388-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
MA2637103T00000X
CT000378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist