Provider Demographics
NPI:1205553682
Name:VAUGHN, TANYA LASHELLE (LGPC, NCC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LASHELLE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11113 BALTIMORE AVE UNIT 120
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2149
Mailing Address - Country:US
Mailing Address - Phone:240-583-1414
Mailing Address - Fax:
Practice Address - Street 1:11113 BALTIMORE AVE UNIT 120
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2149
Practice Address - Country:US
Practice Address - Phone:240-583-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional