Provider Demographics
NPI:1033897939
Name:VAUGHAN, TEVIN D (RBT)
Entity Type:Individual
Prefix:
First Name:TEVIN
Middle Name:D
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 E LITTLE CREEK RD APT 201
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4215
Mailing Address - Country:US
Mailing Address - Phone:757-714-7292
Mailing Address - Fax:
Practice Address - Street 1:293 INDEPENDENCE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5461
Practice Address - Country:US
Practice Address - Phone:757-785-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician