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General NPI Number Information
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NPI Number | 1083270227
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Entity Type | Organization
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Legal Business Name | KATHRYN VAUGHN LLC
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 3160 MAIN ST STE 102
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City | DULUTH
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State | GA
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Zip | 30096-3461
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Country | US
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Telephone | 470-426-5281
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Fax |
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Provider Business Mailing Address
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Address Line | 3968 MAINSAIL CT
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City | DULUTH
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State | GA
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Zip | 30096-5281
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Country | US
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Telephone | 678-557-0934
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | KATHRYN IRENE VAUGHN
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Credential | LCSW
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Telephone | 470-426-5281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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