Provider Demographics
NPI:1588162424
Name:GARCIA-SANDOVAL, MARISOL
Entity type:Individual
Prefix:MISS
First Name:MARISOL
Middle Name:
Last Name:GARCIA-SANDOVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3946 MARCOM ST APT F
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2826
Mailing Address - Country:US
Mailing Address - Phone:919-222-8200
Mailing Address - Fax:
Practice Address - Street 1:6300 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-4243
Practice Address - Country:US
Practice Address - Phone:919-854-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician