Healthcare Provider Details

I. General information

NPI: 1114025657
Provider Name (Legal Business Name): COURTNEY MARIE VAUGHAN LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9649 BELAIR RD SUITE 104
NOTTINGHAM MD
21236-1023
US

IV. Provider business mailing address

9649 BELAIR RD SUITE 104
NOTTINGHAME MD
21236
US

V. Phone/Fax

Practice location:
  • Phone: 410-529-1309
  • Fax: 410-529-1005
Mailing address:
  • Phone: 410-529-1309
  • Fax: 410-529-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17300
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: