Provider Demographics
NPI:1841323607
Name:COUNCIL, CHRISTY VAUGHN (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:VAUGHN
Last Name:COUNCIL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:7233 MINE SHAFT RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6019
Mailing Address - Country:US
Mailing Address - Phone:919-676-5718
Mailing Address - Fax:919-212-7024
Practice Address - Street 1:3725 NATIONAL DR STE 114
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4879
Practice Address - Country:US
Practice Address - Phone:919-784-0508
Practice Address - Fax:919-212-7024
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2994103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000739Medicaid