Provider Demographics
NPI:1437420635
Name:VAUGHAN, LORA JEAN (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:JEAN
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 PAINTERS MILL RD
Mailing Address - Street 2:STE. 204
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3641
Mailing Address - Country:US
Mailing Address - Phone:443-394-3838
Mailing Address - Fax:443-394-0345
Practice Address - Street 1:66 PAINTERS MILL RD
Practice Address - Street 2:STE. 204
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3641
Practice Address - Country:US
Practice Address - Phone:443-394-3838
Practice Address - Fax:443-394-0345
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional