Organization
CETIFIED DIVA HAIR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKISHA SOUTHWELL (OWNER)
(646) 592-0927
Entity
Organization
Contact information
Practice address
200 LUDLOW ST # 26, STAMFORD, CT 06902-7075
(646) 529-0402
Mailing address
200 LUDLOW ST # 26, STAMFORD, CT 06902-7075
(646) 529-0402
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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