Healthcare Provider Details

I. General information

NPI: 1225649197
Provider Name (Legal Business Name): DOMONIQUE E SOTO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 THOMPSON AVE
SELMA CA
93662-2497
US

IV. Provider business mailing address

PO BOX 391
DINUBA CA
93618-0391
US

V. Phone/Fax

Practice location:
  • Phone: 559-847-5956
  • Fax:
Mailing address:
  • Phone: 559-305-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: