Provider Demographics
NPI:1164052544
Name:SOUFAN, DEEMA (LMHC)
Entity Type:Individual
Prefix:
First Name:DEEMA
Middle Name:
Last Name:SOUFAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 NW RUSTLING FIR LN
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7867
Mailing Address - Country:US
Mailing Address - Phone:708-870-0312
Mailing Address - Fax:
Practice Address - Street 1:9307 BAY SHORE DR NW # 304
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8219
Practice Address - Country:US
Practice Address - Phone:206-635-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health