Provider Demographics
NPI:1972224194
Name:VAUGHAN-DIXON, CALLAS (MPA, MA, LCPC)
Entity Type:Individual
Prefix:
First Name:CALLAS
Middle Name:
Last Name:VAUGHAN-DIXON
Suffix:
Gender:F
Credentials:MPA, MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10411 MOTOR CITY DR STE 750-1043
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1008
Mailing Address - Country:US
Mailing Address - Phone:202-294-9715
Mailing Address - Fax:
Practice Address - Street 1:8609 2ND AVE STE 404B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3374
Practice Address - Country:US
Practice Address - Phone:301-377-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14222101YM0800X
MDLGP11069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health