Healthcare Provider Details

I. General information

NPI: 1598691354
Provider Name (Legal Business Name): A MOTHER'S VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W WABASH AVE
EUREKA CA
95501-2827
US

IV. Provider business mailing address

1836 OLD ARCATA RD UNIT 165
BAYSIDE CA
95524-2204
US

V. Phone/Fax

Practice location:
  • Phone: 707-633-3143
  • Fax:
Mailing address:
  • Phone: 707-633-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISTY DICKERSON
Title or Position: FOUNDER
Credential:
Phone: 707-633-3143