Individual
TARA D. ANCRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5740 ANCRUM BUTLER LN, HOLLYWOOD, SC 29449-7101
(843) 437-0372
Mailing address
5740 ANCRUM BUTLER LN, HOLLYWOOD, SC 29449-7101
(843) 437-0372
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6126
SC
101YM0800X
Mental Health Counselor
6589
SC
101YP2500X
Professional Counselor
Primary
6589
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
435201
—
SC
Enumeration date
07/25/2016
Last updated
04/21/2022
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