Provider Demographics
NPI:1871377671
Name:VIVIFY PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:VIVIFY PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:864-301-1303
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-0321
Mailing Address - Country:US
Mailing Address - Phone:864-301-1303
Mailing Address - Fax:
Practice Address - Street 1:108 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1715
Practice Address - Country:US
Practice Address - Phone:864-301-1303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)