Provider Demographics
NPI:1336800507
Name:VAUGHAN, AMY T (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 DUNCRAIG DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3335
Mailing Address - Country:US
Mailing Address - Phone:434-237-9450
Mailing Address - Fax:434-237-9454
Practice Address - Street 1:7537 CARROLLTON PIKE UNIT 2
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-4269
Practice Address - Country:US
Practice Address - Phone:434-237-9450
Practice Address - Fax:434-237-9454
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701011092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional