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General NPI Number Information
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NPI Number | 1073134573
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Entity Type | Organization
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Legal Business Name | DIVA SALON BY VERONICA ASHLEY, INC.
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 10901 UNIVERSITY CITY BLVD STE 108
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City | CHARLOTTE
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State | NC
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Zip | 28213-9300
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Country | US
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Telephone | 704-601-6021
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 KIRK FARM LN APT 107
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City | CHARLOTTE
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State | NC
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Zip | 28213-4032
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Country | US
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Telephone | 704-713-7130
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VERONICA WILLIAMS
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Credential |
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Telephone | 704-713-7130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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