Provider Demographics
NPI:1528207453
Name:RENFRO, SANDRA W (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:W
Last Name:RENFRO
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:BELL
Other - Last Name:RENFRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CADC
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-956-0727
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-956-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0604101YA0400X
KY11791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)