MEDICARE: MS. DARLENE HOLLAND TERRY LCSW

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	1041C0700X	Clinical Social Worker	05101188C	AL
2	1041C0700X	Clinical Social Worker	I-07570	NM

General Provider Information

NPI Number	:	1902995046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DARLENE HOLLAND TERRY LCSW

Provider Business Mailing Address
First Line	:	13 BEVERLY HTS
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35404-2911
Country	:	US
Telephone Number	:	205-242-6919
Fax Number	:	205-737-7615

Provider Business Practice Location Address
First Line	:	13 BEVERLY HTS
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35404-2911
Country	:	US
Telephone Number	:	205-242-6919
Fax Number	:	205-737-7615

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/21/2022

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