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Organization
SECRET GURU PERMANENT MAKEUP
Active
Organization
SECRET GURU PERMANENT MAKEUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA SOUTHERS MASTERS BOARD CERT. (OWNER)
(804) 615-7476
Entity
Organization
Contact information
Practice address
587 SOUTHLAKE BLVD STE A, NORTH CHESTERFIELD, VA 23236-3096
(804) 895-7616
Mailing address
3511 BELLBLUFF DR, NORTH CHESTERFIELD, VA 23237-1002
Taxonomy
Speciality
Code
Description
License number
State
246ZA2600X
Medical Art Specialist/Technologist
Primary
—
NULL
246ZA2600X
Medical Art Specialist/Technologist
Primary
—
—
Other
Enumeration date
01/24/2023
Last updated
01/24/2023
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