Provider Demographics
NPI:1467937573
Name:HOFLAND, MANDY JO (LAC)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:JO
Last Name:HOFLAND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:JO
Other - Last Name:HERRMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:651 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3136
Mailing Address - Country:US
Mailing Address - Phone:701-371-4105
Mailing Address - Fax:
Practice Address - Street 1:510 4TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1914
Practice Address - Country:US
Practice Address - Phone:701-476-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1832101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)