Provider Demographics
NPI:1366238388
Name:SOTO, KASSONDRA (LCSW)
Entity type:Individual
Prefix:
First Name:KASSONDRA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KASSONDRA
Other - Middle Name:MAE
Other - Last Name:GROTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 AQUAMARINE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8070
Mailing Address - Country:US
Mailing Address - Phone:847-212-9558
Mailing Address - Fax:
Practice Address - Street 1:1108 BIRCH ST
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2518
Practice Address - Country:US
Practice Address - Phone:910-451-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0182771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical