Healthcare Provider Details

I. General information

NPI: 1477481869
Provider Name (Legal Business Name): DIVINE CROWN HAIR LOSS SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 S CHURCH ST
BURLINGTON NC
27215-5396
US

IV. Provider business mailing address

2280 S CHURCH ST
BURLINGTON NC
27215-5396
US

V. Phone/Fax

Practice location:
  • Phone: 336-213-8385
  • Fax:
Mailing address:
  • Phone: 336-213-8385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE DENISE MORROW
Title or Position: CERTIFCRANIAL PROTHESIS SPECIALIST
Credential: CRANIAL PROTHESIS SP
Phone: 336-213-8385