Healthcare Provider Details

I. General information

NPI: 1326546987
Provider Name (Legal Business Name): VAUGHAN CENTER FOR PERSONAL GROWTH AND DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36400 WOODWARD AVE STE 125
BLOOMFIELD HILLS MI
48304
US

IV. Provider business mailing address

421 WIMBLETON DR
BIRMINGHAM MI
48009-7600
US

V. Phone/Fax

Practice location:
  • Phone: 248-752-1275
  • Fax:
Mailing address:
  • Phone: 248-752-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA MARIE VAUGHAN
Title or Position: PRESIDENT
Credential:
Phone: 248-752-1275