Provider Demographics
NPI:1124225834
Name:SANDOVAL, JULIE C (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:C
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8918 CUMBERLAND CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6572
Mailing Address - Country:US
Mailing Address - Phone:704-315-8042
Mailing Address - Fax:
Practice Address - Street 1:225 E KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4743
Practice Address - Country:US
Practice Address - Phone:704-315-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0055401041C0700X
NYR057771-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical