Healthcare Provider Details

I. General information

NPI: 1497521157
Provider Name (Legal Business Name): BLACK GIRLS NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 BOYLSTON ST. 6TH FL ATTN: BLACK GIRLS NUTRITION
BOSTON MA
02116
US

IV. Provider business mailing address

399 BOYLSTON ST. 6TH FL ATTN: BLACK GIRLS NUTRITION
BOSTON MA
02116
US

V. Phone/Fax

Practice location:
  • Phone: 857-370-8321
  • Fax:
Mailing address:
  • Phone: 857-370-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: KATIA POWELL-LAURENT
Title or Position: FOUNDER
Credential:
Phone: 857-370-8321