Healthcare Provider Details

I. General information

NPI: 1649189440
Provider Name (Legal Business Name): HAIR JUNKIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MALLET HILL RD APT 1001
COLUMBIA SC
29223-4415
US

IV. Provider business mailing address

811 MALLET HILL RD APT 1001
COLUMBIA SC
29223-4415
US

V. Phone/Fax

Practice location:
  • Phone: 839-246-1184
  • Fax:
Mailing address:
  • Phone: 839-246-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: YASMINE GRIFFIETH
Title or Position: CEO
Credential:
Phone: 839-246-1184