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General NPI Number Information
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NPI Number | 1396581948
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Entity Type | Individual
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Provider Name | KOBIE HEARL COBURN MS
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Gender | Male
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Dates
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Enumeration Date | 07/03/2024
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 1608 THIRD AVENUE
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City | WILLIAMSON
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State | WV
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Zip | 25661
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Country | US
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Telephone | 304-235-0026
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Fax | 304-235-0028
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Provider Business Mailing Address
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Address Line | 3758 GARRETTS FORK RD
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City | CHAPMANVILLE
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State | WV
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Zip | 25508-8733
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Country | US
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Telephone | 304-784-1312
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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