Provider Demographics
NPI:1326670381
Name:VAUGHN, BRADLEY DUANE (LCMHC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DUANE
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 E DIXON BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6893
Mailing Address - Country:US
Mailing Address - Phone:704-487-4000
Mailing Address - Fax:
Practice Address - Street 1:1243 E DIXON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6893
Practice Address - Country:US
Practice Address - Phone:704-487-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health