Provider Demographics
NPI:1659572667
Name:VAUGHAN, MARVIN K
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:K
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WEBSTER ROAD
Mailing Address - Street 2:SENECA HEALTH SERVICES INC
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651
Mailing Address - Country:US
Mailing Address - Phone:304-872-6577
Mailing Address - Fax:304-872-5415
Practice Address - Street 1:100 CHURCH STREET
Practice Address - Street 2:SENECA HEALTH SERVICES INC
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901
Practice Address - Country:US
Practice Address - Phone:304-645-3319
Practice Address - Fax:304-645-6532
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker