MEDICARE: DIVINE CHARIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1235061565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE CHARIS LLC

Provider Business Mailing Address
First Line	:	17 GREEN VALLEY LN
Second Line	:
City	:	JACKSON SPRINGS
State	:	NC
Zip	:	27281-9798
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 GREEN VALLEY LN
Second Line	:
City	:	JACKSON SPRINGS
State	:	NC
Zip	:	27281-9798
Country	:	US
Telephone Number	:	443-531-6637
Fax Number	:

Authorized Official
Title or Position	:	BIRTH & POSTPARTUM DOULA
Name	:	MRS. DIARA FITZGERALD
Credential	:
Telephone Number	:	443-531-6637

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “DIVINE CHARIS LLC ” Practice Location

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