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General NPI Number Information
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NPI Number | 1205553682
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Entity Type | Individual
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Provider Name | TANYA LASHELLE VAUGHN LGPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 11113 BALTIMORE AVE UNIT 120
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City | BELTSVILLE
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State | MD
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Zip | 20705-2149
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Country | US
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Telephone | 240-583-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 11113 BALTIMORE AVE UNIT 120
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City | BELTSVILLE
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State | MD
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Zip | 20705-2149
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Country | US
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Telephone | 240-583-1414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LGP13014
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License Number State | MD
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