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General NPI Number Information
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NPI Number | 1841987195
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Entity Type | Individual
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Provider Name | JACKIE ALICIA GREEN-AUGUST CCHW
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Gender | Female
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 5963 NAMOZINE RD
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City | CREWE
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State | VA
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Zip | 23930-2734
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Country | US
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Telephone | 434-298-4012
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Fax |
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Provider Business Mailing Address
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Address Line | 5963 NAMOZINE RD
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City | CREWE
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State | VA
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Zip | 23930-2734
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Country | US
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Telephone | 434-298-4012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | VA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 3465
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License Number State | VA
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