Healthcare Provider Details

I. General information

NPI: 1780095562
Provider Name (Legal Business Name): DISTRICT DOULAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 KENNEDY ST
ALEXANDRIA VA
22305-2517
US

IV. Provider business mailing address

8413 FLOWER AVE APT 4
TAKOMA PARK MD
20912-6732
US

V. Phone/Fax

Practice location:
  • Phone: 215-380-3945
  • Fax:
Mailing address:
  • Phone: 215-380-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number133461
License Number StateVA

VIII. Authorized Official

Name: CANDICE JONES
Title or Position: BIRTH DOULA
Credential:
Phone: 215-380-3945