Provider Demographics
NPI:1710111067
Name:HOFMAN, JOAN ELISE (MA, LPC, LLC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ELISE
Last Name:HOFMAN
Suffix:
Gender:F
Credentials:MA, LPC, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 FOREST HILL AVE SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7954
Mailing Address - Country:US
Mailing Address - Phone:616-974-5594
Mailing Address - Fax:
Practice Address - Street 1:2565 FOREST HILL AVE SE
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7954
Practice Address - Country:US
Practice Address - Phone:616-974-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional