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General NPI Number Information
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NPI Number | 1689634255
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Entity Type | Individual
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Provider Name | VAUGHN A DECOSTER MSW, PHD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 4979 OLD GREENWOOD RD STE B2
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City | FORT SMITH
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State | AR
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Zip | 72903-6906
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Country | US
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Telephone | 479-289-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 775 LAUREL DR
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City | GREENWOOD
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State | AR
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Zip | 72936-5714
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Country | US
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Telephone | 479-445-9814
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3738-C
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License Number State | AR
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