Provider Demographics
NPI:1770189904
Name:VIBRANT HEALTH CHOICE, PLLC
Entity type:Organization
Organization Name:VIBRANT HEALTH CHOICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-949-1367
Mailing Address - Street 1:1247 CARR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4544
Mailing Address - Country:US
Mailing Address - Phone:866-901-3621
Mailing Address - Fax:662-673-3910
Practice Address - Street 1:1247 CARR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2610
Practice Address - Country:US
Practice Address - Phone:866-901-3621
Practice Address - Fax:662-673-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty