MEDICARE: DEMETRIA MONE WILLINGHAM

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	:	1730800798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRIA MONE WILLINGHAM

Provider Business Mailing Address
First Line	:	5700 OLD RICHMOND AVE STE D17
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1828
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2219 COMMONWEALTH DR APT A
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1530
Country	:	US
Telephone Number	:	434-529-0464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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Directions to “ DEMETRIA MONE WILLINGHAM ” Practice Location

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