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General NPI Number Information
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NPI Number | 1912726068
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Entity Type | Organization
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Legal Business Name | CROWN TO SOUL
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 547 ARNETT BLVD
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City | DANVILLE
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State | VA
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Zip | 24540-2554
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Country | US
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Telephone | 434-548-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 OLDE HUNTING TRL
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City | DANVILLE
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State | VA
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Zip | 24540-5107
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Country | US
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Telephone | 434-709-7656
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRITTANY SLADE
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Credential | CMT, QMHP-A/C, DOULA
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Telephone | 434-709-7656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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