Organization
COVENANT CRANIAL MEDICAL WIGS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LASATT NICHELE TILLMAN (OWNER/INSTRUCTOR)
(804) 451-8343
Entity
Organization
Contact information
Practice address
1021 BOULEVARD, COLONIAL HGTS, VA 23834-3258
(804) 844-6359
Mailing address
8307 SCOTT PL, RICHMOND, VA 23227-1100
(804) 451-8343
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/27/2026
Last updated
04/27/2026
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