Provider Demographics
NPI:1487834453
Name:SANDIFER-BETHEA, SHARON LAYNE (TEXAS LCDC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LAYNE
Last Name:SANDIFER-BETHEA
Suffix:
Gender:F
Credentials:TEXAS LCDC
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:LAYNE
Other - Last Name:SANDIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TEXAS LCDC
Mailing Address - Street 1:1600 UNIVERSITY DR E
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2642
Mailing Address - Country:US
Mailing Address - Phone:979-691-3397
Mailing Address - Fax:979-691-3332
Practice Address - Street 1:1600 UNIVERSITY DR E
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2642
Practice Address - Country:US
Practice Address - Phone:979-691-3397
Practice Address - Fax:979-691-3332
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCDC2902101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8664BHOtherBCBS