# TRICHOLOGY HAIR LOSS PREVENTION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013629963
- **Authorized official:** LEOLA MCMILLAN TRICHOLOGY HAIR LOSS (PRACTITIONER)
- **Authorized official phone:** (336) 918-8521

## Contact information

- **Practice address:** 470 KNOLLWOOD ST, WINSTON SALEM, NC 27103-3426
- **Practice address phone:** (336) 986-9063
- **Mailing address:** PO BOX 11762, WINSTON SALEM, NC 27116-1762
- **Mailing address phone:** (336) 986-9063
- **Mailing address fax:** (336) 306-9713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 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