Healthcare Provider Details

I. General information

NPI: 1720919350
Provider Name (Legal Business Name): MOTHER UP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 BRAMBLETON AVE
CAVE SPRING VA
24018-3727
US

IV. Provider business mailing address

3142 BRAMBLETON AVE
CAVE SPRING VA
24018-3727
US

V. Phone/Fax

Practice location:
  • Phone: 509-342-4752
  • Fax:
Mailing address:
  • Phone: 509-342-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KATIE DOUGLAS
Title or Position: FOUNDER
Credential:
Phone: 509-342-4752