Provider Demographics
NPI:1376066365
Name:VAUGHN, AUNDRA SIMMONS (LPC)
Entity Type:Individual
Prefix:DR
First Name:AUNDRA
Middle Name:SIMMONS
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 BREEZE WAY AVE NE
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:GA
Mailing Address - Zip Code:31331-6511
Mailing Address - Country:US
Mailing Address - Phone:912-342-2788
Mailing Address - Fax:877-408-8199
Practice Address - Street 1:15938 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:GA
Practice Address - Zip Code:31331-3706
Practice Address - Country:US
Practice Address - Phone:912-342-2788
Practice Address - Fax:877-408-8199
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008947101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003201308AMedicaid