Provider Demographics
NPI:1336503804
Name:VAUGHN, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:B
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:6236 NELL CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-5412
Mailing Address - Country:US
Mailing Address - Phone:540-293-7601
Mailing Address - Fax:
Practice Address - Street 1:2840 ELECTRIC RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3551
Practice Address - Country:US
Practice Address - Phone:540-772-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional