Healthcare Provider Details

I. General information

NPI: 1023407368
Provider Name (Legal Business Name): TARA COBURN SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 OLD LATTA HWY
DILLON SC
29536-7614
US

IV. Provider business mailing address

PO BOX 1090
HARTSVILLE SC
29551-1090
US

V. Phone/Fax

Practice location:
  • Phone: 843-774-4337
  • Fax: 843-774-4373
Mailing address:
  • Phone: 843-857-0111
  • Fax: 843-309-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10671
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: