MEDICARE: EDO YOUNG DOULA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach
2	374J00000X	Doula

General Provider Information

NPI Number	:	1992402366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDO YOUNG DOULA

Provider Business Mailing Address
First Line	:	3007 STOCKTON ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-3549
Country	:	US
Telephone Number	:	571-253-9591
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 STOCKTON ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-3549
Country	:	US
Telephone Number	:	571-253-9591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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Directions to “ EDO YOUNG DOULA” Practice Location

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