Provider Demographics
NPI:1629283338
Name:HOFFMAN, JESSICA DUBBERLY (PHD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DUBBERLY
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PHD
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 245
Mailing Address - Street 2:20 E 1ST STREET
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-0245
Mailing Address - Country:US
Mailing Address - Phone:828-464-3900
Mailing Address - Fax:
Practice Address - Street 1:20 E 1ST ST
Practice Address - Street 2:20 E 1ST STREET
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3200
Practice Address - Country:US
Practice Address - Phone:828-464-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3271103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC047AEOtherBCBS