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General NPI Number Information
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NPI Number | 1871760397
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Entity Type | Individual
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Provider Name | EBONY SAMARA GIDDINS VAUGHAN LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 9199 REISTERSTOWN RD STE 204B
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4593
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Country | US
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Telephone | 410-382-4536
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Fax | 410-655-1329
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Provider Business Mailing Address
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Address Line | 3839 JANBROOK RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-2705
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Country | US
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Telephone | 410-382-4536
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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 | 12666
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License Number State | MD
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