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General NPI Number Information
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NPI Number | 1366238388
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Entity Type | Individual
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Provider Name | KASSONDRA SOTO LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1108 BIRCH ST
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2518
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Country | US
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Telephone | 910-451-7290
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Fax |
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Provider Business Mailing Address
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Address Line | 318 AQUAMARINE CIR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-8070
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Country | US
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Telephone | 847-212-9558
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C018277
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License Number State | NC
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