Provider Demographics
NPI:1245981505
Name:VAUGHAN, TENEISHA SHANTA
Entity type:Individual
Prefix:
First Name:TENEISHA
Middle Name:SHANTA
Last Name:VAUGHAN
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 1:307 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-1829
Mailing Address - Country:US
Mailing Address - Phone:252-396-3298
Mailing Address - Fax:
Practice Address - Street 1:2211 S MILITARY HWY STE B23320
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5987
Practice Address - Country:US
Practice Address - Phone:757-633-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060120671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical