Provider Demographics
NPI:1578942272
Name:SANDOVAL, JUAN ANTONIO JR (LCDCI)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ANTONIO
Last Name:SANDOVAL
Suffix:JR
Gender:M
Credentials:LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1815 GARNER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6209
Mailing Address - Country:US
Mailing Address - Phone:830-591-1822
Mailing Address - Fax:830-591-1826
Practice Address - Street 1:1815 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-6209
Practice Address - Country:US
Practice Address - Phone:830-591-1822
Practice Address - Fax:830-591-1826
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17448101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)