Provider Demographics
NPI:1235650508
Name:VAUGHAN, ALLISON MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MICHELLE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 SUMMERSET DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-1938
Mailing Address - Country:US
Mailing Address - Phone:757-714-2431
Mailing Address - Fax:
Practice Address - Street 1:17579 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23603-1343
Practice Address - Country:US
Practice Address - Phone:757-888-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health