Provider Demographics
NPI:1295086536
Name:GREEN, SOTHIA LASHAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SOTHIA
Middle Name:LASHAN
Last Name:GREEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MIDTOWN SQ
Mailing Address - Street 2:APT 5027
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4418
Mailing Address - Country:US
Mailing Address - Phone:301-613-6043
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 260
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-613-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA 341101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)