Provider Demographics
NPI:1609140441
Name:SANDEFER, DAVID LONNIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LONNIE
Last Name:SANDEFER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3852 ORLEANS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5639
Mailing Address - Country:US
Mailing Address - Phone:205-967-0844
Mailing Address - Fax:
Practice Address - Street 1:6324 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2537
Practice Address - Country:US
Practice Address - Phone:334-272-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical