Healthcare Provider Details

I. General information

NPI: 1033897939
Provider Name (Legal Business Name): TEVIN D VAUGHAN RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 INDEPENDENCE BLVD STE 400
VIRGINIA BEACH VA
23462-5461
US

IV. Provider business mailing address

1805 E LITTLE CREEK RD APT 201
NORFOLK VA
23518-4215
US

V. Phone/Fax

Practice location:
  • Phone: 757-785-3338
  • Fax:
Mailing address:
  • Phone: 757-714-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: