Provider Demographics
NPI:1841612496
Name:DIMITRA THEOHARIS PSYD LMHC PA
Entity Type:Organization
Organization Name:DIMITRA THEOHARIS PSYD LMHC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEOHARIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMHC
Authorized Official - Phone:954-783-0035
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty