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General NPI Number Information
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NPI Number | 1164052544
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Entity Type | Individual
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Provider Name | DEEMA SOUFAN LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 9307 BAY SHORE DR NW # 304
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City | SILVERDALE
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State | WA
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Zip | 98383-8219
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Country | US
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Telephone | 206-635-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 NW RUSTLING FIR LN
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City | SILVERDALE
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State | WA
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Zip | 98383-7867
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Country | US
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Telephone | 708-870-0312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.015627
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License Number State | IL
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