MEDICARE: DENAEE NICOLE VAUGHN

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	1041C0700X	Clinical Social Worker	P021424	NC

General Provider Information

NPI Number	:	1740166362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENAEE NICOLE VAUGHN

Provider Business Mailing Address
First Line	:	2018 FORT BRAGG RD STE 122A&B
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-7037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 FORT BRAGG RD STE 122A&B
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-7037
Country	:	US
Telephone Number	:	910-758-8778
Fax Number	:

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	03/23/2026

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