Provider Demographics
NPI:1023879152
Name:SOTO, JENNY C (LPC-A)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:C
Last Name:SOTO
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 JASMINE DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-1504
Mailing Address - Country:US
Mailing Address - Phone:704-771-5592
Mailing Address - Fax:
Practice Address - Street 1:5501 EXECUTIVE CENTER DR STE 215
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8823
Practice Address - Country:US
Practice Address - Phone:704-771-5592
Practice Address - Fax:888-972-4998
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-29160101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)