Provider Demographics
NPI:1164913042
Name:VAUGHN, GLORIA TULANI (LCSWA)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:TULANI
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 CANIPE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5198
Mailing Address - Country:US
Mailing Address - Phone:704-904-6281
Mailing Address - Fax:
Practice Address - Street 1:4305 CANIPE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5198
Practice Address - Country:US
Practice Address - Phone:704-904-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0111551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical