Provider Demographics
NPI:1528702263
Name:SOSA, XIOMARA A (LPCA)
Entity type:Individual
Prefix:
First Name:XIOMARA
Middle Name:A
Last Name:SOSA
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 CENTRAL AVE STE E-1
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3743
Mailing Address - Country:US
Mailing Address - Phone:843-970-0678
Mailing Address - Fax:
Practice Address - Street 1:820 CENTRAL AVE STE E-1
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3743
Practice Address - Country:US
Practice Address - Phone:843-970-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health