Provider Demographics
NPI:1467247544
Name:SANDEFUR, CARON RENEE (LICSW-S PIP)
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:RENEE
Last Name:SANDEFUR
Suffix:
Gender:
Credentials:LICSW-S PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8980 PRITCHETT RD
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-3254
Mailing Address - Country:US
Mailing Address - Phone:205-914-6794
Mailing Address - Fax:
Practice Address - Street 1:1501 DECATUR HWY STE 101
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-3857
Practice Address - Country:US
Practice Address - Phone:205-914-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1183C-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical