Provider Demographics
NPI:1356500896
Name:SANDOVAL, ANGIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9075
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-9075
Mailing Address - Country:US
Mailing Address - Phone:530-636-0511
Mailing Address - Fax:
Practice Address - Street 1:55 INDEPENDENCE CIR
Practice Address - Street 2:STE 104
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4909
Practice Address - Country:US
Practice Address - Phone:530-636-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759031041C0700X
CA288481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356500896OtherNPI