Provider Demographics
NPI:1306687876
Name:HOFFMAN, KIMBERLY FAYE (LISAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAYE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PEACOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2929
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:4616 N 51ST AVE STE 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1720
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-269-8410
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-155328101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)