Healthcare Provider Details

I. General information

NPI: 1922848779
Provider Name (Legal Business Name): SIERRA LOGAN VAUGHAN LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CLUB VILLA CT BLDG B
KATHLEEN GA
31047-5496
US

IV. Provider business mailing address

133 CAMELOT RD
GRAY GA
31032-3860
US

V. Phone/Fax

Practice location:
  • Phone: 478-449-1475
  • Fax:
Mailing address:
  • Phone: 478-663-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT000811
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: