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NPI Code Detail

MEDICARE: MARCIE L VAUGHAN

MEDICARE: MARCIE L VAUGHAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist864WV

General Provider Information

NPI Number : 1104986835
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCIE L VAUGHAN
Provider Business Mailing Address
First Line : 131 WELLNESS DR
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-5402
Country : US
Telephone Number : 304-872-6503
Fax Number : 304-872-5415
Provider Business Practice Location Address
First Line : 131 WELLNESS DR
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-5402
Country : US
Telephone Number : 304-872-6503
Fax Number : 304-872-5541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2006
Last Update Date : 04/19/2022

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Directions to “ MARCIE L VAUGHAN ” Practice Location

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