Individual provider Active NPI

Amanda Vaughan, LCSW

  • Clinical Social Worker
  • Greensboro, NC
National Provider Identifier
1760554158
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C004291 Issued in NC
Practice address
315 E Washington St
Greensboro, NC 27401-2911
Phone
(336) 387-6161
Fax
(336) 387-9167
NPI assigned
Nov 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X C004291 NC Primary

Addresses

Primary practice location

315 E Washington St
Greensboro, NC 27401-2911

Mailing address

902 Bonner Dr
Jamestown, NC 27282-8948
Phone (336) 387-6161

Other identifiers 1

IdentifierTypeStateIssuer
6003711MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110106000545 NC Practitioner - Clinical Social Worker 7911196936 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C004291NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Rha Health Services, Inc CurrentSince Feb 1, 2014 Accepting new patients
Rha Health Services Inc CurrentSince Feb 1, 2014 Accepting new patients
Rha Health Services Inc Current Accepting new patients
Grounded for Peace Wellness Services, PLLC Current Accepting new patients

Locations

211 Perimeter Center Pkwy NE
Ste 750
Atlanta, GA 30346

1100 Revolution Mill Dr
Ste 8
Greensboro, NC 27405

211 S Centennial St
High Point, NC 27260
Phone (336) 841-0143

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1760554158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 BONNER DR",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272828948",
            "telephone_number": "336-387-6161",
            "fax_number": "336-387-9167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E WASHINGTON ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274012911",
            "telephone_number": "336-387-6161",
            "fax_number": "336-387-9167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "AMANDA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6003711",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.