Provider Demographics
NPI:1518514306
Name:SANDOVAL RODAS, KELLIN ALEXIS (LCSW)
Entity type:Individual
Prefix:
First Name:KELLIN
Middle Name:ALEXIS
Last Name:SANDOVAL RODAS
Suffix:
Gender:M
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:UNIT 28037
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112-8037
Mailing Address - Country:US
Mailing Address - Phone:323-592-0324
Mailing Address - Fax:
Practice Address - Street 1:UNIT 28037
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112-8037
Practice Address - Country:US
Practice Address - Phone:637-194-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC016239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health