Provider Demographics
NPI:1902625759
Name:DOULA LAB
Entity type:Organization
Organization Name:DOULA LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:SADE
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:CMA, CFSD, CHW, SPM
Authorized Official - Phone:618-570-3169
Mailing Address - Street 1:6400 W MAIN ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3806
Mailing Address - Country:US
Mailing Address - Phone:618-213-6800
Mailing Address - Fax:
Practice Address - Street 1:6400 W MAIN ST STE 1D
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3806
Practice Address - Country:US
Practice Address - Phone:618-213-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty