Provider Demographics
NPI:1265973937
Name:HOFFMANN, RICHARD JOSEPH SR (LICDC & LPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:HOFFMANN
Suffix:SR
Gender:M
Credentials:LICDC & LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 TIMBERCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2930
Mailing Address - Country:US
Mailing Address - Phone:419-520-8850
Mailing Address - Fax:567-205-5060
Practice Address - Street 1:1230 TIMBERCLIFF DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2930
Practice Address - Country:US
Practice Address - Phone:419-520-8850
Practice Address - Fax:567-205-5060
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161969101YA0400X
OHC.2002440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290637Medicaid