MEDICARE: DR. CHRISTY VAUGHN COUNCIL PHD

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	103TC0700X	Clinical Psychologist	2994	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841323607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTY VAUGHN COUNCIL PHD

Provider Business Mailing Address
First Line	:	7233 MINE SHAFT RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6019
Country	:	US
Telephone Number	:	919-676-5718
Fax Number	:	919-212-7024

Provider Business Practice Location Address
First Line	:	3725 NATIONAL DR STE 114
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-4879
Country	:	US
Telephone Number	:	919-784-0508
Fax Number	:	919-212-7024

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	01/15/2009

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