Provider Demographics
NPI:1306691951
Name:HOFFMANN, DIANA MAUREEN (LCISWA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MAUREEN
Last Name:HOFFMANN
Suffix:
Gender:U
Credentials:LCISWA
Other - Prefix:
Other - First Name:LANE
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:CMR 469 BOX 1108
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09227-0012
Mailing Address - Country:US
Mailing Address - Phone:360-799-5782
Mailing Address - Fax:
Practice Address - Street 1:436 MCPHEE RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5014
Practice Address - Country:US
Practice Address - Phone:360-799-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61506716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker