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General NPI Number Information
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NPI Number | 1467105486
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Entity Type | Organization
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Legal Business Name | VIVID MINDS MENTAL CARE
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 159 HOPEWELL DR
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City | OCOEE
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State | FL
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Zip | 34761-4445
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Country | US
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Telephone | 239-357-1945
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 OCOEE APOPKA RD STE 106
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City | OCOEE
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State | FL
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Zip | 34761-5344
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Country | US
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Telephone | 239-357-1945
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MARCELLINE L GIRLIE
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Credential | APRN, FNP, PMHNP
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Telephone | 239-357-1945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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