Healthcare Provider Details

I. General information

NPI: 1699637272
Provider Name (Legal Business Name): DANA GLAD FARRAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NICK'S KIDS AVENUE
TUSCALOOSA AL
35401
US

IV. Provider business mailing address

17 PINEHURST DR
TUSCALOOSA AL
35401-1148
US

V. Phone/Fax

Practice location:
  • Phone: 205-737-3720
  • Fax:
Mailing address:
  • Phone: 205-564-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6505C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: