Provider Demographics
NPI:1407604762
Name:MID-MISSOURI BLACK DOULA COLLECTIVE
Entity type:Organization
Organization Name:MID-MISSOURI BLACK DOULA COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-424-5485
Mailing Address - Street 1:2801 S CABERNET CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8723
Mailing Address - Country:US
Mailing Address - Phone:573-424-5485
Mailing Address - Fax:
Practice Address - Street 1:601 W BUSINESS LOOP 70 STE 214B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2566
Practice Address - Country:US
Practice Address - Phone:573-424-5485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty