Provider Demographics
NPI:1689634255
Name:DECOSTER, VAUGHN A (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:A
Last Name:DECOSTER
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF ARKANSAS
Mailing Address - Street 2:106 ASUP
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-1201
Mailing Address - Country:US
Mailing Address - Phone:479-575-7903
Mailing Address - Fax:479-575-4145
Practice Address - Street 1:1617 N APPLEBURY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-2418
Practice Address - Country:US
Practice Address - Phone:479-521-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1887-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical