Healthcare Provider Details

I. General information

NPI: 1124172499
Provider Name (Legal Business Name): RAINTREE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 STAMPER RD SUITE 101
FAYETTEVILLE NC
28303-4379
US

IV. Provider business mailing address

804 STAMPER RD SUITE 101
FAYETTEVILLE NC
28303-4379
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-2875
  • Fax: 910-323-1355
Mailing address:
  • Phone: 910-323-2875
  • Fax: 910-323-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number50018
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHL-026-176
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN D.A. VAUGHN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 910-323-2875