Provider Demographics
NPI:1740528215
Name:VAUGHN, JAMIE L (LCSW)
Entity type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:L
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 BROADWATER DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3872
Mailing Address - Country:US
Mailing Address - Phone:704-641-4645
Mailing Address - Fax:
Practice Address - Street 1:4102 BROADWATER DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3872
Practice Address - Country:US
Practice Address - Phone:704-641-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0081471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical