Healthcare Provider Details

I. General information

NPI: 1235061565
Provider Name (Legal Business Name): DIVINE CHARIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 GREEN VALLEY LN
JACKSON SPRINGS NC
27281-9798
US

IV. Provider business mailing address

17 GREEN VALLEY LN
JACKSON SPRINGS NC
27281-9798
US

V. Phone/Fax

Practice location:
  • Phone: 443-531-6637
  • Fax:
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. DIARA FITZGERALD
Title or Position: BIRTH & POSTPARTUM DOULA
Credential:
Phone: 443-531-6637