Healthcare Provider Details

I. General information

NPI: 1902625759
Provider Name (Legal Business Name): DOULA LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 W MAIN ST
BELLEVILLE IL
62223-3026
US

IV. Provider business mailing address

6608 W MAIN ST
BELLEVILLE IL
62223-3026
US

V. Phone/Fax

Practice location:
  • Phone: 618-213-6800
  • Fax:
Mailing address:
  • Phone: 618-213-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MISS CHARITY SADE BEAN
Title or Position: PRESIDENT, CEO
Credential: CMA, CFSD, CHW, SPM
Phone: 618-213-6800