Provider Demographics
NPI:1558962266
Name:COTHRAN, TARA (MA, LPC-S, ADC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:MA, LPC-S, ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 FOLLY ROAD BLVD STE B9
Mailing Address - Street 2:#1034
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7551
Mailing Address - Country:US
Mailing Address - Phone:864-593-9544
Mailing Address - Fax:
Practice Address - Street 1:900 BOWMAN ROAD SUITE 103
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:864-593-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5611103TC1900X
SC8035101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling