Provider Demographics
NPI:1235680265
Name:VAUGHANS, DORIS
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:
Last Name:VAUGHANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GARDEN PKWY APT 537
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3881
Mailing Address - Country:US
Mailing Address - Phone:334-201-9146
Mailing Address - Fax:
Practice Address - Street 1:3518 LOOP RD STE 4
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5091
Practice Address - Country:US
Practice Address - Phone:334-201-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL2921101YP2500X
GALPC008350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional