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General NPI Number Information
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NPI Number | 1124936612
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Entity Type | Organization
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Legal Business Name | KINGDOM RETREAT SALON AND MORE LLC
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Dates
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Enumeration Date | 08/28/2026
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Last Update Date | 08/28/2026
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Provider Practice Location Address
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Address Line | 12680 W LAKE HOUSTON PKWY STE 500
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City | HOUSTON
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State | TX
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Zip | 77044-6088
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Country | US
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Telephone | 832-850-0968
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Fax |
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Provider Business Mailing Address
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Address Line | 12680 W LAKE HOUSTON PKWY STE 500
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City | HOUSTON
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State | TX
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Zip | 77044-6088
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Country | US
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Telephone | 832-850-0968
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Fax |
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Authorized Official
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Title or Position | CLINICAL TRICHOLOGIST
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Name | MRS. LATRICE WILLIAMS-TOLBERT
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Credential | TC, HLPC,
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Telephone | 832-850-0968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #5
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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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