Provider Demographics
NPI:1366147761
Name:VAUGHN, MARLIE (LMHC)
Entity type:Individual
Prefix:
First Name:MARLIE
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MERRIMON AVE # 1182
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2322
Mailing Address - Country:US
Mailing Address - Phone:352-434-2399
Mailing Address - Fax:
Practice Address - Street 1:1175 LUCERNE DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3639
Practice Address - Country:US
Practice Address - Phone:352-434-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health