Healthcare Provider Details

I. General information

NPI: 1275608903
Provider Name (Legal Business Name): DONNA VAUGHAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MAIN ST FL 3
MIDDLETOWN CT
06457-3423
US

IV. Provider business mailing address

169 MAIN ST FL 3
MIDDLETOWN CT
06457-3423
US

V. Phone/Fax

Practice location:
  • Phone: 203-819-0789
  • Fax:
Mailing address:
  • Phone: 203-819-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7137
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001812A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: