Provider Demographics
NPI:1962608588
Name:HOFFMAN MILLER, NICOLE MICHELE (PSYD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELE
Last Name:HOFFMAN MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MICHELE
Other - Last Name:HOFFMAN MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4423 SUSANNA CT
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-8530
Mailing Address - Country:US
Mailing Address - Phone:540-759-0037
Mailing Address - Fax:540-404-2126
Practice Address - Street 1:3697 E WILSON ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1683
Practice Address - Country:US
Practice Address - Phone:540-418-0105
Practice Address - Fax:540-404-2126
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0810004434103TC2200X, 103TF0000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962608588Medicaid
CA7420Medicaid