Individual
JENNIFER SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADAC
Contact information
Practice address
01 SAGEBRUSH STREET, ISLETA, NM 87022
(505) 869-5474
(505) 869-4584
Mailing address
PO BOX 640, ISLETA, NM 87022
(505) 869-5474
(505) 869-4584
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3850
NM
Other
Enumeration date
09/15/2005
Last updated
05/16/2012
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