Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TH0004X | Health Psychologist | ||
Y | 103TH0100X | Health Service | ||
N | 103TH0100X | Health Service | VA |
NPI | 1316542566 |
---|---|
Provider Name | Erica Vaughan |
First Address | Virginia Beach, VA 23452-1109 |
Second Address | Virginia Beach, VA 23452-1109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2020 |
Last Update Date | 03/12/2020 |