Provider Demographics
NPI:1164202198
Name:VAUGHN, GINA (MSW)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 LOLA CIR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7995
Mailing Address - Country:US
Mailing Address - Phone:717-598-8784
Mailing Address - Fax:
Practice Address - Street 1:7710 LOLA CIR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7995
Practice Address - Country:US
Practice Address - Phone:717-598-8784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW14660101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor