Provider Demographics
NPI:1790454304
Name:KING, KALISHA (CD-CERTIFIED DOULA)
Entity Type:Individual
Prefix:MRS
First Name:KALISHA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:CD-CERTIFIED DOULA
Other - Prefix:MRS
Other - First Name:KALISHA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD- CERTIFIED DOULA
Mailing Address - Street 1:10433 RAPIDAN LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6450
Mailing Address - Country:US
Mailing Address - Phone:571-528-4867
Mailing Address - Fax:
Practice Address - Street 1:10433 RAPIDAN LANE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109
Practice Address - Country:US
Practice Address - Phone:571-528-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty