Provider Demographics
NPI:1184890378
Name:DIANE HOFSTADTER, LLC
Entity type:Organization
Organization Name:DIANE HOFSTADTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFSTADTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-818-6024
Mailing Address - Street 1:5714 MACKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1422
Mailing Address - Country:US
Mailing Address - Phone:405-818-6024
Mailing Address - Fax:
Practice Address - Street 1:129 PARK ST NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4603
Practice Address - Country:US
Practice Address - Phone:405-818-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty