Provider Demographics
NPI:1154800563
Name:FARRIS, DAVID ALEX (LAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEX
Last Name:FARRIS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 6TH AVE SE STE 504
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6563
Mailing Address - Country:US
Mailing Address - Phone:479-310-6925
Mailing Address - Fax:
Practice Address - Street 1:2128 6TH AVE SE STE 504
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6563
Practice Address - Country:US
Practice Address - Phone:479-310-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1808120101YM0800X
ALLPC05586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health