Healthcare Provider Details

I. General information

NPI: 1932083466
Provider Name (Legal Business Name): VIVD MIND PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CLOVER HILL LN
SPRING CITY PA
19475-2312
US

IV. Provider business mailing address

80 CLOVER HILL LN
SPRING CITY PA
19475-2312
US

V. Phone/Fax

Practice location:
  • Phone: 570-460-6808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MEGHAN ELIZABETH CHARLES
Title or Position: OWNER
Credential: PMHNP
Phone: 570-460-6808