| Doctor Name: | MRS. TARA COBURN |
| NPI Number: | 1023407368 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SOCIAL WORKER |
| License Number: | 10671 |
| Business Practice Address: | 207 E Monroe St Dillon, SC - 295362557 |
| Business Phone Number: | 8437744337 |
| Business Fax Number: | 8437744373 |
| Mailing Address: | 712 N Main St, NICHOLS |
| State: | SC |
| Postal Code: | 295817237 |
| Phone Number: | 8438452074 |
| Fax Number: | |
| NPI Enumeration Date: | 01/09/2015 |
| NPI Last Update Date: | 05/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 10671 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |