Healthcare Provider Details

I. General information

NPI: 1568688968
Provider Name (Legal Business Name): GRETCHEN GISELLA SOTO L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. GRETCHEN GISELLA ASSANAH

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 WILD CHERRY RD
WINDSOR MILL MD
21244-2909
US

IV. Provider business mailing address

3407 WILD CHERRY RD
WINDSOR MILL MD
21244-2909
US

V. Phone/Fax

Practice location:
  • Phone: 703-798-3899
  • Fax:
Mailing address:
  • Phone: 703-798-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003663
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: