Provider Demographics
NPI:1326896879
Name:CARROLL, REVITAL (DOULA, CMT, CEIM)
Entity type:Individual
Prefix:
First Name:REVITAL
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DOULA, CMT, CEIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3538
Mailing Address - Country:US
Mailing Address - Phone:928-713-7123
Mailing Address - Fax:
Practice Address - Street 1:326 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3538
Practice Address - Country:US
Practice Address - Phone:928-713-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist