Provider Demographics
NPI:1164048799
Name:SADEKNI, VAUGHN RUSSO (LPC)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:RUSSO
Last Name:SADEKNI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 N SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2522
Mailing Address - Country:US
Mailing Address - Phone:724-433-2380
Mailing Address - Fax:
Practice Address - Street 1:111 ROBERTS RD STE 150
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-2104
Practice Address - Country:US
Practice Address - Phone:724-785-4346
Practice Address - Fax:724-364-4346
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty