Healthcare Provider Details

I. General information

NPI: 1669166500
Provider Name (Legal Business Name): YOUNGER SALON INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 09/06/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 BACKLICK RD STE D
SPRINGFIELD VA
22150-2637
US

IV. Provider business mailing address

1803 HYDEN PL
WOODBRIDGE VA
22191-4435
US

V. Phone/Fax

Practice location:
  • Phone: 571-230-6302
  • Fax:
Mailing address:
  • Phone: 571-230-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI YOUNGER RUSSELL
Title or Position: CERTIFIED HAIR LOSS EXPERT
Credential:
Phone: 571-230-6302