Healthcare Provider Details

I. General information

NPI: 1316841885
Provider Name (Legal Business Name): SEANTAJAH LOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 FAYETTE AVE
RICHMOND VA
23222-1319
US

IV. Provider business mailing address

612 FAYETTE AVE
RICHMOND VA
23222-1319
US

V. Phone/Fax

Practice location:
  • Phone: 804-668-6078
  • Fax:
Mailing address:
  • Phone: 804-668-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: