Individual
KYLE D VAUGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
214 BUSH RIVER DRIVE, FARMVILLE, VA 23901
(434) 392-3187
(434) 392-5789
Mailing address
P.O. BOX 248, FARMVILLE, VA 23901
(434) 392-3187
(434) 392-5789
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701004337
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945450
—
VA
Enumeration date
08/19/2008
Last updated
08/19/2008
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