Provider Demographics
NPI:1578882460
Name:VAUGHN, SHERYL A (LPC)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:A
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 1:120 S PARK SQ NE
Mailing Address - Street 2:#206
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8602
Mailing Address - Country:US
Mailing Address - Phone:770-419-5752
Mailing Address - Fax:770-419-5752
Practice Address - Street 1:120 S PARK SQ NE
Practice Address - Street 2:#206
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8602
Practice Address - Country:US
Practice Address - Phone:770-419-5752
Practice Address - Fax:770-419-5752
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health