Provider Demographics
NPI:1083270227
Name:KATHRYN VAUGHN LLC
Entity Type:Organization
Organization Name:KATHRYN VAUGHN LLC
Other - Org Name:KATHRYN VAUGHN LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:470-426-5281
Mailing Address - Street 1:3968 MAINSAIL CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5281
Mailing Address - Country:US
Mailing Address - Phone:678-557-0934
Mailing Address - Fax:
Practice Address - Street 1:3160 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3461
Practice Address - Country:US
Practice Address - Phone:470-426-5281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health