Healthcare Provider Details

I. General information

NPI: 1134023609
Provider Name (Legal Business Name): YONIQUE BEAUTY, LLC DBA HEALTHY HAIR ETC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N MALL DR #111-122
VIRGINIA BEACH VA
23452
US

IV. Provider business mailing address

1568 HUMMINGBIRD LN
VIRGINIA BEACH VA
23454
US

V. Phone/Fax

Practice location:
  • Phone: 757-598-1217
  • Fax:
Mailing address:
  • Phone: 757-598-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORRAINE GARCIA BEZA AMMERMAN
Title or Position: MANAGER/HAIR LOSS SPECIALIST
Credential:
Phone: 757-839-9518