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General NPI Number Information
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NPI Number | 1841223591
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Entity Type | Individual
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Provider Name | LINDA SUE COEBURN LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 2700 S ROAN ST STE 203
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City | JOHNSON CITY
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State | TN
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Zip | 37601-7557
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Country | US
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Telephone | 423-202-3033
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Fax |
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Provider Business Mailing Address
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Address Line | 549 W STONE DR
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City | KINGSPORT
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State | TN
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Zip | 37660-3212
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Country | US
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Telephone | 423-202-3033
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004718
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | TNLSW0000006900
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License Number State | TN
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