Provider Demographics
NPI:1750445888
Name:VAUGHT, DONNA RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:RAE
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 CABLE CAR LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3669
Mailing Address - Country:US
Mailing Address - Phone:910-256-9353
Mailing Address - Fax:
Practice Address - Street 1:2516 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-7161
Practice Address - Country:US
Practice Address - Phone:910-796-9969
Practice Address - Fax:910-796-0270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2212103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent