Provider Demographics
NPI:1497095939
Name:FARMER, CAROLYN ANDRIETTE VAUGHN (MS, EDS, LPA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANDRIETTE VAUGHN
Last Name:FARMER
Suffix:
Gender:F
Credentials:MS, EDS, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6729 FAIRVIEW RD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-0127
Mailing Address - Country:US
Mailing Address - Phone:704-962-8349
Mailing Address - Fax:
Practice Address - Street 1:6729 FAIRVIEW RD STE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0127
Practice Address - Country:US
Practice Address - Phone:704-962-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3801103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist