Provider Demographics
NPI:1124739834
Name:CREATE YOUR LIFE DOULA AND COACHING SERVICES
Entity type:Organization
Organization Name:CREATE YOUR LIFE DOULA AND COACHING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:BASHELLIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-418-2917
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-0658
Mailing Address - Country:US
Mailing Address - Phone:404-418-2917
Mailing Address - Fax:
Practice Address - Street 1:1345 KENT MNR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7926
Practice Address - Country:US
Practice Address - Phone:404-418-2917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty