Provider Demographics
NPI:1639313034
Name:SOULOUNIAS-ARRIAGA, DEMETRIA (BA, BCABA)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
Last Name:SOULOUNIAS-ARRIAGA
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4953 CAMBRIDGE BLVD
Mailing Address - Street 2:# 202
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-4149
Mailing Address - Country:US
Mailing Address - Phone:727-474-2007
Mailing Address - Fax:
Practice Address - Street 1:4953 CAMBRIDGE BLVD
Practice Address - Street 2:# 202
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-4149
Practice Address - Country:US
Practice Address - Phone:727-474-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0030767103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst