# SECRET GURU PERMANENT MAKEUP

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

## Provider details

- **NPI number:** 1033825062
- **Authorized official:** CHRISTINA SOUTHERS MASTERS BOARD CERT. (OWNER)
- **Authorized official phone:** (804) 615-7476

## Contact information

- **Practice address:** 587 SOUTHLAKE BLVD STE A, NORTH CHESTERFIELD, VA 23236-3096
- **Practice address phone:** (804) 895-7616
- **Mailing address:** 3511 BELLBLUFF DR, NORTH CHESTERFIELD, VA 23237-1002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246ZA2600X | Medical Art Specialist/Technologist | — | NULL | Yes |
| 246ZA2600X | Medical Art Specialist/Technologist | — | — | Yes |

## Other

- **Enumeration date:** 01/24/2023
- **Last updated:** 01/24/2023