Healthcare Provider Details

I. General information

NPI: 1992402366
Provider Name (Legal Business Name): EDO YOUNG DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 STOCKTON ST
RICHMOND VA
23224-3549
US

IV. Provider business mailing address

3007 STOCKTON ST
RICHMOND VA
23224-3549
US

V. Phone/Fax

Practice location:
  • Phone: 571-253-9591
  • Fax:
Mailing address:
  • Phone: 571-253-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: