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General NPI Number Information
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NPI Number | 1639395759
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Entity Type | Organization
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Legal Business Name | BODY & FACE LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 323-D EAST MEADOW RD
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City | EDEN
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State | NC
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Zip | 27288-3400
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Country | US
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Telephone | 336-623-7400
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Fax | 336-623-4511
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Provider Business Mailing Address
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Address Line | 323-D EAST MEADOW RD
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City | EDEN
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State | NC
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Zip | 27288-3400
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Country | US
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Telephone | 336-623-7400
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Fax | 336-623-4511
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Authorized Official
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Title or Position | OWNERTHERAPIST
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Name | MRS. PENNY S DIXON
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Credential | LMBT
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Telephone | 336-623-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 830
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License Number State | NC
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