Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY003639 | GA |
N | 103T00000X | Psychologist | PSY003639 | GA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY003639 | GA |
NPI | 1215240775 |
---|---|
Provider Name | Dr. Kristi Leigh Hofstadter-Duke |
First Address | Savannah, GA 31404-6220 |
Second Address | Savannah, GA 31406-4674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003129989A | (05) | GA |
003129989B | (05) | GA |
003129989C | (05) | GA |
P01315374 | RAILROAD MEDICARE (01) | GA |
PS0559 | (05) | SC |