Provider Demographics
NPI:1205390820
Name:SOTO, STEPHANIE (MA, APCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:MA, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2609
Mailing Address - Country:US
Mailing Address - Phone:619-643-9307
Mailing Address - Fax:
Practice Address - Street 1:224 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2609
Practice Address - Country:US
Practice Address - Phone:619-643-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8090101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN0675360008-8OtherHPSO STUDENT LIABILITY INSURANCE