Provider Demographics
NPI:1447226030
Name:SANDOVAL-CARPENTER, ANTOINETTE (LPCC)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:SANDOVAL-CARPENTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 UNSER BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6300
Mailing Address - Country:US
Mailing Address - Phone:505-896-2520
Mailing Address - Fax:
Practice Address - Street 1:1717 GROS VENTRE DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-7783
Practice Address - Country:US
Practice Address - Phone:505-350-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0080401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM86284720Medicaid