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General NPI Number Information
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NPI Number | 1467247544
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Entity Type | Individual
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Provider Name | CARON RENEE SANDEFUR LICSW-S PIP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 1501 DECATUR HWY STE 101
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City | GARDENDALE
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State | AL
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Zip | 35071-3857
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Country | US
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Telephone | 205-914-6794
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Fax |
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Provider Business Mailing Address
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Address Line | 8980 PRITCHETT RD
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City | GARDENDALE
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State | AL
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Zip | 35071-3254
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Country | US
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Telephone | 205-914-6794
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1183C-S
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License Number State | AL
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