MEDICARE: GLORIA GOODRUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1578421731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA GOODRUM

Provider Business Mailing Address
First Line	:	330 ELORA RD
Second Line	:
City	:	HUNTLAND
State	:	TN
Zip	:	37345-4818
Country	:	US
Telephone Number	:	931-308-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 DRAKE AVE SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-5199
Country	:	US
Telephone Number	:	256-881-1311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ GLORIA GOODRUM ” Practice Location

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