Provider Demographics
NPI:1891299954
Name:VAUGHAN, BRIAN STEPHEN (LPC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:STEPHEN
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 OLDE GREENWICH DR STE 210
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4002
Mailing Address - Country:US
Mailing Address - Phone:540-847-2876
Mailing Address - Fax:540-371-4333
Practice Address - Street 1:150 OLDE GREENWICH DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4002
Practice Address - Country:US
Practice Address - Phone:540-847-2876
Practice Address - Fax:540-371-4333
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA07007559OtherTHERAPIST