Provider Demographics
NPI:1194237420
Name:SANDEFUR, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SANDEFUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24160 WALDEN RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-7714
Mailing Address - Country:US
Mailing Address - Phone:423-341-7320
Mailing Address - Fax:855-610-2288
Practice Address - Street 1:24160 WALDEN RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-7714
Practice Address - Country:US
Practice Address - Phone:423-341-7320
Practice Address - Fax:855-610-2288
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001025103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst