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Organization
TRICHOLOGY HAIR LOSS PREVENTION
Active
Organization
TRICHOLOGY HAIR LOSS PREVENTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEOLA MCMILLAN TRICHOLOGY HAIR LOSS (PRACTITIONER)
(336) 918-8521
Entity
Organization
Contact information
Practice address
470 KNOLLWOOD ST, WINSTON SALEM, NC 27103-3426
(336) 986-9063
Mailing address
PO BOX 11762, WINSTON SALEM, NC 27116-1762
(336) 986-9063
(336) 306-9713
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
NULL
174400000X
Specialist
—
—
1744P3200X
Prosthetics Case Management
—
NULL
1744P3200X
Prosthetics Case Management
—
—
224P00000X
Prosthetist
—
NULL
224P00000X
Prosthetist
—
—
261Q00000X
Clinic/Center
—
NULL
261QV0200X
VA Clinic/Center
Primary
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332BC3200X
Customized Equipment (DME)
—
NULL
335E00000X
Prosthetic/Orthotic Supplier
—
NULL
Other
Enumeration date
12/21/2022
Last updated
03/30/2026
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