Provider Demographics
NPI:1619734506
Name:DE GROOT, JONI (LICENSED MFT)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:DE GROOT
Suffix:
Gender:F
Credentials:LICENSED MFT
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1951 47TH ST SPC 47
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1380
Mailing Address - Country:US
Mailing Address - Phone:619-828-0281
Mailing Address - Fax:
Practice Address - Street 1:1951 47TH ST SPC 47
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1380
Practice Address - Country:US
Practice Address - Phone:619-828-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health