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General NPI Number Information
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NPI Number | 1669065876
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Entity Type | Organization
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Legal Business Name | MOTHER WELL DOULA SERVICE, LLC
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 406 CHESTNUT ST
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City | BEREA
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State | KY
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Zip | 40403-1998
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Country | US
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Telephone | 859-582-7955
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Fax |
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Provider Business Mailing Address
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Address Line | 121 CASSIUS CT
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City | BEREA
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State | KY
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Zip | 40403-2012
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Country | US
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Telephone | 859-582-7955
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Fax |
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Authorized Official
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Title or Position | OWNER, DOULA
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Name | VICTORIA WILSON
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Credential | CD(DONA)
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Telephone | 859-582-7955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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