Provider Demographics
NPI:1194271205
Name:HOFFMAN, NINA ELISA (MA, MFTI)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:ELISA
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:MS
Other - First Name:NINA
Other - Middle Name:ELISA
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MFTI
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2077
Mailing Address - Country:US
Mailing Address - Phone:707-467-2010
Mailing Address - Fax:
Practice Address - Street 1:110 E MENDOCINO AVE
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490
Practice Address - Country:US
Practice Address - Phone:707-459-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77079225C00000X
CAIMF77079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor