Provider Demographics
NPI:1871169425
Name:GREEN-SOTO, ANDREA G (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:G
Last Name:GREEN-SOTO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 STONEBRIER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2247
Mailing Address - Country:US
Mailing Address - Phone:843-812-4029
Mailing Address - Fax:
Practice Address - Street 1:1700 WELLS RD STE 11
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2373
Practice Address - Country:US
Practice Address - Phone:904-800-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4802101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional