Provider Demographics
NPI:1992863674
Name:HOFFMAN, MELISSA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL ROAD, 11B-45
Mailing Address - Street 2:
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5851
Mailing Address - Country:US
Mailing Address - Phone:706-631-7283
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL ROAD
Practice Address - Street 2:11B-45
Practice Address - City:FT. GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW71621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical