Healthcare Provider Details

I. General information

NPI: 1356256937
Provider Name (Legal Business Name): L.A. HAIR BOUTIQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S HIGHWAY 14 UNIT N
GREER SC
29650-4943
US

IV. Provider business mailing address

2740 S HIGHWAY 14 UNIT N
GREER SC
29650-4943
US

V. Phone/Fax

Practice location:
  • Phone: 864-641-0751
  • Fax:
Mailing address:
  • Phone: 864-641-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER DOUGLAS GUEST
Title or Position: CEO
Credential:
Phone: 864-415-5727