Provider Demographics
NPI:1598589384
Name:CHARVAT, VIVIAN FAYE (LMBT)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:FAYE
Last Name:CHARVAT
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 SHELBY HWY LOT 3
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-9681
Mailing Address - Country:US
Mailing Address - Phone:619-323-8850
Mailing Address - Fax:
Practice Address - Street 1:107 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4445
Practice Address - Country:US
Practice Address - Phone:704-692-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist