Healthcare Provider Details

I. General information

NPI: 1487588422
Provider Name (Legal Business Name): DIVINE DOULA SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12534 N 142ND LN
SURPRISE AZ
85379-5586
US

IV. Provider business mailing address

7776 S POINTE PKWY E SUITE 101
PHOENIX AZ
85044
US

V. Phone/Fax

Practice location:
  • Phone: 602-775-8405
  • Fax: 602-775-8405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISHA CLEMONS
Title or Position: DOULA/BIRTHWORKER
Credential:
Phone: 602-775-8405