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General NPI Number Information
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NPI Number | 1902059876
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Entity Type | Organization
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Legal Business Name | TIMOTHY L. VAUGHN COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 630 WINCHESTER AVE
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City | MARTINSBURG
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State | WV
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Zip | 25401-2102
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Country | US
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Telephone | 304-886-8975
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Fax |
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Provider Business Mailing Address
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Address Line | 59 THORNBERRY DR
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City | MARTINSBURG
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State | WV
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Zip | 25403-8782
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Country | US
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Telephone | 304-886-8975
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | TIMOTHY LLOYD VAUGHN
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Credential | MA, LPC
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Telephone | 304-886-8975
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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 | 1900
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License Number State | WV
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