Provider Demographics
NPI:1497637367
Name:VAUGHTERS, JAMAR
Entity type:Individual
Prefix:
First Name:JAMAR
Middle Name:
Last Name:VAUGHTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 UNIVERSITY HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4076
Mailing Address - Country:US
Mailing Address - Phone:704-783-7414
Mailing Address - Fax:
Practice Address - Street 1:211 S CENTER ST STE 409
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5873
Practice Address - Country:US
Practice Address - Phone:704-232-1470
Practice Address - Fax:704-795-6212
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0225681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty