Provider Demographics
NPI:1083926604
Name:VAUGHN, MATTHEW G (LPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:G
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4015 S COBB DR SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6303
Mailing Address - Country:US
Mailing Address - Phone:770-851-3823
Mailing Address - Fax:770-863-0009
Practice Address - Street 1:4015 S COBB DR SE
Practice Address - Street 2:SUITE 100
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6303
Practice Address - Country:US
Practice Address - Phone:770-851-3823
Practice Address - Fax:770-863-0009
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC005910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional