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General NPI Number Information
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NPI Number | 1902535321
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Entity Type | Organization
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Legal Business Name | EXECUTIVE DOULA AGENCY, LLC
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 100 MARIE PL
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-2931
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Country | US
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Telephone | 703-981-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 977 SEMINOLE TRL # 276
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-2824
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNELL LYNCH
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Credential |
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Telephone | 703-981-6688
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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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