Provider Demographics
NPI:1609505460
Name:COMMUNITY DOULAS OF WACO
Entity Type:Organization
Organization Name:COMMUNITY DOULAS OF WACO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONJA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC,RLC, PCD(DONA)
Authorized Official - Phone:254-307-0377
Mailing Address - Street 1:4300 W WACO DR # B2-228
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7010
Mailing Address - Country:US
Mailing Address - Phone:254-307-0377
Mailing Address - Fax:254-296-1241
Practice Address - Street 1:2505 WASHINGTON AVE STE 10
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7408
Practice Address - Country:US
Practice Address - Phone:254-307-0377
Practice Address - Fax:254-296-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty