Provider Demographics
NPI:1124370648
Name:VAUGHAN, ZANDRA CHINAE (MSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:ZANDRA
Middle Name:CHINAE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 LONG NEEDLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9462
Mailing Address - Country:US
Mailing Address - Phone:803-524-4714
Mailing Address - Fax:
Practice Address - Street 1:411 LONG NEEDLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9462
Practice Address - Country:US
Practice Address - Phone:803-524-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO79651041C0700X
SC107821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical