Provider Demographics
NPI:1194519900
Name:VAUGHN, ROSALENA
Entity type:Individual
Prefix:MS
First Name:ROSALENA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 HIGHWAY 82 W LOT 34
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38756-9341
Mailing Address - Country:US
Mailing Address - Phone:662-394-0322
Mailing Address - Fax:
Practice Address - Street 1:1654 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3250
Practice Address - Country:US
Practice Address - Phone:662-335-5274
Practice Address - Fax:662-378-3976
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker