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NPI Code Detail

MEDICARE: JENNY VAUGHN

MEDICARE: JENNY VAUGHN
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
1101YM0800XMental Health CounselorA17658NC

General Provider Information

NPI Number : 1164155032
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY VAUGHN
Provider Business Mailing Address
First Line : 3804 PARK AVE STE C
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6737
Country : US
Telephone Number : 910-240-4473
Fax Number :
Provider Business Practice Location Address
First Line : 3804 PARK AVE STE C
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-6737
Country : US
Telephone Number : 910-240-4473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2022
Last Update Date : 07/07/2022

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Directions to “ JENNY VAUGHN ” Practice Location

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