Provider Demographics
NPI:1205646668
Name:DEVAUGHN, NIA IMAN
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:IMAN
Last Name:DEVAUGHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SHENANDOAH LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-3624
Mailing Address - Country:US
Mailing Address - Phone:743-433-1036
Mailing Address - Fax:
Practice Address - Street 1:3950 COBB PKWY NW STE 501
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9529
Practice Address - Country:US
Practice Address - Phone:404-536-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health