Individual
ELIZABETH GRACE SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHCA
Contact information
Practice address
131 W LEBANON ST STE C&E, MOUNT AIRY, NC 27030-2935
(336) 716-0855
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-9034
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
A19748
NC
101YP2500X
Professional Counselor
Primary
A19748
NC
Other
Enumeration date
02/19/2024
Last updated
11/20/2024
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