Healthcare Provider Details

I. General information

NPI: 1639953797
Provider Name (Legal Business Name): CASSAUNDRA VAUGHN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 UNION LAKE RD STE B
COMMERCE TOWNSHIP MI
48382-4501
US

IV. Provider business mailing address

3133 UNION LAKE RD STE B
COMMERCE TOWNSHIP MI
48382-4501
US

V. Phone/Fax

Practice location:
  • Phone: 248-462-6530
  • Fax:
Mailing address:
  • Phone: 248-266-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225564
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: