Provider Demographics
NPI:1952426389
Name:HOFFMAN-FOWLER, ELAINE CAROL
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CAROL
Last Name:HOFFMAN-FOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:CAROL
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1783 FAIROAKS PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1450
Mailing Address - Country:US
Mailing Address - Phone:404-281-8354
Mailing Address - Fax:
Practice Address - Street 1:5073 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3536
Practice Address - Country:US
Practice Address - Phone:770-938-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000828106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist