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General NPI Number Information
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NPI Number | 1275086480
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Entity Type | Individual
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Provider Name | TARA D. ANCRUM LPC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 5740 ANCRUM BUTLER LN
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City | HOLLYWOOD
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State | SC
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Zip | 29449-7101
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Country | US
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Telephone | 843-437-0372
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Fax |
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Provider Business Mailing Address
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Address Line | 5740 ANCRUM BUTLER LN
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City | HOLLYWOOD
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State | SC
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Zip | 29449-7101
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Country | US
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Telephone | 843-437-0372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6589
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6126
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6589
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License Number State | SC
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