Provider Demographics
NPI:1366972226
Name:VAUGHN, ANACAROLINA (MS, MED, LMHC)
Entity type:Individual
Prefix:
First Name:ANACAROLINA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:MS, MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WAYMONT CT STE 126-10
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3413
Mailing Address - Country:US
Mailing Address - Phone:321-848-1916
Mailing Address - Fax:407-603-0414
Practice Address - Street 1:200 WAYMONT CT STE 126-10
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3413
Practice Address - Country:US
Practice Address - Phone:321-848-1916
Practice Address - Fax:407-603-0414
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15912101YP2500X, 103K00000X
FL15912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst