Healthcare Provider Details

I. General information

NPI: 1447226030
Provider Name (Legal Business Name): ANTOINETTE SANDOVAL-CARPENTER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 GROS VENTRE DR NE
RIO RANCHO NM
87144-7783
US

IV. Provider business mailing address

12 UNSER BLVD SE
RIO RANCHO NM
87124-6300
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-6643
  • Fax:
Mailing address:
  • Phone: 505-896-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0080401
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: