Provider Demographics
NPI:1376009522
Name:VANGUNDY, VICKI VAUGHN (MED)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:VAUGHN
Last Name:VANGUNDY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:1650 PRUDENTIAL DR STE 210
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8149
Practice Address - Country:US
Practice Address - Phone:904-376-3755
Practice Address - Fax:904-396-4942
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH17650101YM0800X
FLMH19714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health