Provider Demographics
NPI:1386727824
Name:HOFSTADTER, DIANE (LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:HOFSTADTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 MACKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1422
Mailing Address - Country:US
Mailing Address - Phone:405-818-6024
Mailing Address - Fax:
Practice Address - Street 1:129 PARK ST NE
Practice Address - Street 2:SUITE 10A
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4603
Practice Address - Country:US
Practice Address - Phone:405-818-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1667101YP2500X
VA0701004826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional