Provider Demographics
NPI:1104047000
Name:VAUGHN, RITA M (MS,LPC,AADC)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:M
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MS,LPC,AADC
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,LPC,AADC
Mailing Address - Street 1:764 WOLFPEN HOLW
Mailing Address - Street 2:
Mailing Address - City:WURTLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41144-7351
Mailing Address - Country:US
Mailing Address - Phone:606-836-2478
Mailing Address - Fax:
Practice Address - Street 1:802 OAK ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530
Practice Address - Country:US
Practice Address - Phone:606-547-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13-306101YA0400X
WV2182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1043706484Medicaid