Provider Demographics
NPI:1194155465
Name:DE POOTER, DIONE (LMFT, MCAP)
Entity type:Individual
Prefix:
First Name:DIONE
Middle Name:
Last Name:DE POOTER
Suffix:
Gender:F
Credentials:LMFT, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 PINES BLVD STE 249
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6180
Mailing Address - Country:US
Mailing Address - Phone:954-367-9149
Mailing Address - Fax:
Practice Address - Street 1:10031 PINES BLVD STE 249
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6180
Practice Address - Country:US
Practice Address - Phone:954-367-9149
Practice Address - Fax:954-416-7755
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5910101YA0400X
FLMT2570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)