Provider Demographics
NPI:1528085461
Name:THEOHARIS, DIMITRA (PSYD, LMHC, PA)
Entity type:Individual
Prefix:DR
First Name:DIMITRA
Middle Name:
Last Name:THEOHARIS
Suffix:
Gender:F
Credentials:PSYD, LMHC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E SAMPLE RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3550
Mailing Address - Country:US
Mailing Address - Phone:954-783-0035
Mailing Address - Fax:954-943-2771
Practice Address - Street 1:150 E SAMPLE RD
Practice Address - Street 2:SUITE # 340
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3550
Practice Address - Country:US
Practice Address - Phone:954-783-0035
Practice Address - Fax:954-943-2771
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health