MEDICARE: SHERYL A VAUGHN LPC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	004600	GA

General Provider Information

NPI Number	:	1578882460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL A VAUGHN LPC

Provider Business Mailing Address
First Line	:	120 S PARK SQ NE
Second Line	:	#206
City	:	MARIETTA
State	:	GA
Zip	:	30060-8602
Country	:	US
Telephone Number	:	770-419-5752
Fax Number	:	770-419-5752

Provider Business Practice Location Address
First Line	:	120 S PARK SQ NE
Second Line	:	#206
City	:	MARIETTA
State	:	GA
Zip	:	30060-8602
Country	:	US
Telephone Number	:	770-419-5752
Fax Number	:	770-419-5752

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

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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