Provider Demographics
NPI:1679765150
Name:SANDERFUR, CHARLES (LPC, MED)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:SANDERFUR
Suffix:
Gender:M
Credentials:LPC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 DEWINE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-4211
Mailing Address - Country:US
Mailing Address - Phone:865-584-6374
Mailing Address - Fax:865-584-6613
Practice Address - Street 1:3343 DEWINE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-4211
Practice Address - Country:US
Practice Address - Phone:865-584-6374
Practice Address - Fax:865-584-6613
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health