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General NPI Number Information
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NPI Number | 1871169425
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Entity Type | Individual
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Provider Name | ANDREA G GREEN-SOTO LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 1700 WELLS RD STE 11
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City | ORANGE PARK
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State | FL
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Zip | 32073-2373
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Country | US
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Telephone | 904-800-9672
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Fax |
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Provider Business Mailing Address
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Address Line | 3133 STONEBRIER RIDGE DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-2247
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Country | US
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Telephone | 843-812-4029
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MT4802
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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