Provider Demographics
NPI:1700249737
Name:THE CENTER FOR NEURODIVERSITY, LLC
Entity Type:Organization
Organization Name:THE CENTER FOR NEURODIVERSITY, LLC
Other - Org Name:THE CENTER FOR NEURODIVERSITY: LEARNING, TEACHING, RESEARCH & SUPPORT,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, DMHS, LICSWA
Authorized Official - Phone:425-931-2728
Mailing Address - Street 1:20006 CEDAR VALLEY RD
Mailing Address - Street 2:SUITE 101E
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-931-2728
Mailing Address - Fax:
Practice Address - Street 1:20006 CEDAR VALLEY RD
Practice Address - Street 2:SUITE 101E
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6334
Practice Address - Country:US
Practice Address - Phone:425-931-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC604434421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty