Healthcare Provider Details

I. General information

NPI: 1366972226
Provider Name (Legal Business Name): ANACAROLINA VAUGHN MS, MED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WAYMONT CT STE 126-10
LAKE MARY FL
32746-3413
US

IV. Provider business mailing address

200 WAYMONT CT STE 126-10
LAKE MARY FL
32746-3413
US

V. Phone/Fax

Practice location:
  • Phone: 321-848-1916
  • Fax: 407-603-0414
Mailing address:
  • Phone: 321-848-1916
  • Fax: 407-603-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15912
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH15912
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH15912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: