Provider Demographics
NPI:1841223591
Name:COEBURN, LINDA SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:COEBURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 W STONE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3212
Mailing Address - Country:US
Mailing Address - Phone:423-202-3033
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST STE 203
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7557
Practice Address - Country:US
Practice Address - Phone:423-202-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047181041C0700X
TNTNLSW00000069001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical