Provider Demographics
NPI:1710197470
Name:HOFFMAN, JACQUIE D (MDIV, DMIN CAND)
Entity Type:Individual
Prefix:
First Name:JACQUIE
Middle Name:D
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MDIV, DMIN CAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SEQUOIA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1514
Mailing Address - Country:US
Mailing Address - Phone:415-355-7100
Mailing Address - Fax:415-355-7101
Practice Address - Street 1:2 SEQUOIA RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1514
Practice Address - Country:US
Practice Address - Phone:415-355-7100
Practice Address - Fax:415-355-7101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral