Provider Demographics
NPI:1770721284
Name:THEODOROU, KATINA (LMHC)
Entity type:Individual
Prefix:MS
First Name:KATINA
Middle Name:
Last Name:THEODOROU
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 1:29 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5546
Mailing Address - Country:US
Mailing Address - Phone:978-786-9660
Mailing Address - Fax:321-805-4156
Practice Address - Street 1:29 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5546
Practice Address - Country:US
Practice Address - Phone:978-786-9660
Practice Address - Fax:321-805-4156
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health