Provider Demographics
NPI:1568497014
Name:VAUGHN, MIKE G (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:G
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3432
Mailing Address - Country:US
Mailing Address - Phone:704-341-5326
Mailing Address - Fax:704-341-5454
Practice Address - Street 1:5801 PINEVILLE MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3432
Practice Address - Country:US
Practice Address - Phone:704-341-5326
Practice Address - Fax:704-341-5454
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist