MEDICARE: ERICA VAUGHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103TH0004X	Health Psychologist
2	103TH0100X	Health Service Psychologist	VA
3	251E00000X	Home Health Agency
4	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1316542566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA VAUGHAN

Provider Business Mailing Address
First Line	:	468 INVESTORS PL STE 204A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1109
Country	:	US
Telephone Number	:	757-904-5091
Fax Number	:	757-904-5090

Provider Business Practice Location Address
First Line	:	468 INVESTORS PL STE 204A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1109
Country	:	US
Telephone Number	:	757-904-5091
Fax Number	:	757-904-5090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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Directions to “ ERICA VAUGHAN ” Practice Location

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