Provider Demographics
NPI:1881027795
Name:VAUGHAN, TERESA (LCPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510A POLLOCK ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5612
Mailing Address - Country:US
Mailing Address - Phone:252-675-8720
Mailing Address - Fax:
Practice Address - Street 1:510A POLLOCK ST
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5612
Practice Address - Country:US
Practice Address - Phone:252-675-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5213101YP2500X
WV2303101YP2500X
NC16687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional