Provider Demographics
NPI:1235694415
Name:PELLICCIA, VAUGHNA MARIE KYSTAL (LPCC)
Entity Type:Individual
Prefix:
First Name:VAUGHNA
Middle Name:MARIE KYSTAL
Last Name:PELLICCIA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 HOLLOW BROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1443
Mailing Address - Country:US
Mailing Address - Phone:719-249-0984
Mailing Address - Fax:
Practice Address - Street 1:2116 HOLLOW BROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1443
Practice Address - Country:US
Practice Address - Phone:719-249-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPP.0021412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty