Provider Demographics
NPI:1861235954
Name:VAUGHN, S. NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:S.
Middle Name:NICOLE
Last Name:VAUGHN
Suffix:
Gender:U
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 OLD MILL RD # 183
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1363
Mailing Address - Country:US
Mailing Address - Phone:803-397-1457
Mailing Address - Fax:
Practice Address - Street 1:672 OLD MILL RD # 183
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1363
Practice Address - Country:US
Practice Address - Phone:803-397-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0109181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical