Individual
JACKIE FAITH SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1001 W BROADWAY, FARMINGTON, NM 87401-5638
(505) 326-2695
Mailing address
1001 W BROADWAY, FARMINGTON, NM 87401-5638
(505) 326-2695
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
M-07749
NM
Other
Enumeration date
06/15/2015
Last updated
06/15/2015
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