Healthcare Provider Details

I. General information

NPI: 1962366211
Provider Name (Legal Business Name): LIFESTYLE HAIR SPALON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 VILLAGE CT
GARNER NC
27529-3600
US

IV. Provider business mailing address

119 STAGG ST
BURLINGTON NC
27217-2653
US

V. Phone/Fax

Practice location:
  • Phone: 919-822-4338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: SHARON COX
Title or Position: CREATIVE DIRECTOR
Credential:
Phone: 919-822-4338