Provider Demographics
NPI:1639967466
Name:VAUGHN-COVINGTON, STACIE (LLMCSW)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:VAUGHN-COVINGTON
Suffix:
Gender:
Credentials:LLMCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4998
Mailing Address - Country:US
Mailing Address - Phone:313-525-8895
Mailing Address - Fax:
Practice Address - Street 1:2056 HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4998
Practice Address - Country:US
Practice Address - Phone:313-525-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511192731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical