Provider Demographics
NPI:1144394065
Name:KIPPS-VAUGHAN, DEBORAH (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:KIPPS-VAUGHAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 E HYCO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-6539
Mailing Address - Country:US
Mailing Address - Phone:434-575-3017
Mailing Address - Fax:434-575-3023
Practice Address - Street 1:3401 OLD HALIFAX RD
Practice Address - Street 2:SUITE F
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4951
Practice Address - Country:US
Practice Address - Phone:434-575-3017
Practice Address - Fax:434-575-3023
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7703627Medicaid