Healthcare Provider Details

I. General information

NPI: 1780507962
Provider Name (Legal Business Name): WATERS OF LIFE DOULA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CHERRY ST
DOVER DE
19904-3412
US

IV. Provider business mailing address

130 CHERRY ST
DOVER DE
19904-3412
US

V. Phone/Fax

Practice location:
  • Phone: 302-242-1580
  • Fax:
Mailing address:
  • Phone: 302-242-1580
  • Fax: 302-242-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JALISA L WATERS
Title or Position: DOULA
Credential: WATERS
Phone: 302-242-1580