Individual
MR. DERIK L SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
2700 SIMPSON AVE, SUITE 101, ABERDEEN, WA 98520
(360) 612-0012
(360) 532-0670
Mailing address
PO BOX 1847, LONGVIEW, WA 98632
(360) 234-0203
(360) 577-0269
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60987238
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2077844
—
WA
Enumeration date
09/07/2020
Last updated
05/05/2021
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