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General NPI Number Information
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NPI Number | 1518514306
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Entity Type | Individual
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Provider Name | KELLIN ALEXIS SANDOVAL RODAS LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | UNIT 28037
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City | APO
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State | AE
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Zip | 09112-8037
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Country | US
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Telephone | 637-194-6430
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 28037
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City | APO
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State | AE
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Zip | 09112-8037
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Country | US
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Telephone | 323-592-0324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C016239
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License Number State | NC
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