Provider Demographics
NPI:1962791814
Name:VONHOFFMANN, CARLY NICOLE
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:NICOLE
Last Name:VONHOFFMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 76TH PLACE NORTHWEST
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-9706
Mailing Address - Country:US
Mailing Address - Phone:360-716-4062
Mailing Address - Fax:360-716-0751
Practice Address - Street 1:4033 76TH PLACE NORTHWEST
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9706
Practice Address - Country:US
Practice Address - Phone:360-716-4062
Practice Address - Fax:360-716-0751
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60543926106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist