Provider Demographics
NPI:1396406682
Name:GOLLIDAY-SANDERS, BRANICIA D (DOULA)
Entity type:Individual
Prefix:MS
First Name:BRANICIA
Middle Name:D
Last Name:GOLLIDAY-SANDERS
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62203-2604
Mailing Address - Country:US
Mailing Address - Phone:618-910-0687
Mailing Address - Fax:
Practice Address - Street 1:140 IOWA AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3940
Practice Address - Country:US
Practice Address - Phone:618-910-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171400000X
174H00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator