Individual
CHARMAYNE N SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
110 E ROUTT AVE, PUEBLO, CO 81004-2117
(719) 543-8711
(719) 543-0171
Mailing address
300 COLORADO AVE, PUEBLO, CO 81004-2006
(719) 543-8711
(719) 543-0171
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
CSW.09923811
CO
1041C0700X
Clinical Social Worker
Primary
CSW.09923811
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61502723
—
CO
Enumeration date
06/06/2011
Last updated
07/20/2021
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