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General NPI Number Information
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NPI Number | 1821164583
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Entity Type | Organization
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Legal Business Name | VAUGHT CHRISTIAN COUNSELING PC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 214 BUSH RIVER DRIVE
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-392-3187
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Fax | 434-392-5789
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Provider Business Mailing Address
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Address Line | 214 BUSH RIVER DRIVE
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City | FARMVILLE
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State | VA
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Zip | 23901
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Country | US
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Telephone | 434-392-3187
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Fax | 434-392-5789
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Authorized Official
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Title or Position | CS IOT COORDINATOR
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Name | MR. KYLE D VAUGHT
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Credential | MA LPC
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Telephone | 434-392-3187
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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 | 2459
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0701004337
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License Number State | VA
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