Healthcare Provider Details

I. General information

NPI: 1851036115
Provider Name (Legal Business Name): PATRICK VAUGHN CIT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 HAYES ST
RAYVILLE LA
71269-2531
US

IV. Provider business mailing address

1135 WALLACE DEAN RD LOT 10
WEST MONROE LA
71291-7760
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-5488
  • Fax:
Mailing address:
  • Phone: 318-307-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCIT-4281
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: