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General NPI Number Information
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NPI Number | 1760637219
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Entity Type | Individual
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Provider Name | WILLARD ALLEN VAUGHN LPC
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Gender | Male
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 110 COLISEUM XING # 6045
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City | HAMPTON
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State | VA
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Zip | 23666-5971
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Country | US
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Telephone | 833-464-5438
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Fax | 757-578-8226
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Provider Business Mailing Address
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Address Line | 110 COLISEUM XING # 6045
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City | HAMPTON
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State | VA
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Zip | 23666-5971
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Country | US
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Telephone | 833-464-5438
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Fax | 757-578-8226
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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 | PRC15236
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC10487
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39003460A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007739
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License Number State | VA
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