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General NPI Number Information
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NPI Number | 1679379481
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Entity Type | Organization
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Legal Business Name | ACTIVATING LIGHT STUDIO LLC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 601 CHETCO AVE STE 3
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City | BROOKINGS
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State | OR
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Zip | 97415-8010
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Country | US
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Telephone | 541-251-8677
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 645
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City | BROOKINGS
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State | OR
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Zip | 97415-0003
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Country | US
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Telephone | 541-251-8677
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA EVELYN GARCIA-HALLMAN
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Credential | CD
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Telephone | 541-251-8677
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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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