Provider Demographics
NPI:1912475286
Name:SOTO, LASHAUNDA CAROLE
Entity Type:Individual
Prefix:
First Name:LASHAUNDA
Middle Name:CAROLE
Last Name:SOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 REFUGE RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-9624
Mailing Address - Country:US
Mailing Address - Phone:864-650-3895
Mailing Address - Fax:
Practice Address - Street 1:515B CAMSON RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1407
Practice Address - Country:US
Practice Address - Phone:864-260-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)