Individual
MARY VAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC I
Contact information
Practice address
2445 W WHITES BRIDGE AVE, FRESNO, CA 93706-1225
(559) 264-2551
Mailing address
1755 E ROBERTS AVE APT 204, FRESNO, CA 93710-6541
(559) 274-5543
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
101YA04000X
CA
Other
Enumeration date
07/22/2016
Last updated
01/22/2019
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