Individual
LAKEATA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSED COSMETOLOGI
Contact information
Practice address
2070 AYRSLEY TOWN BLVD UNIT A, CHARLOTTE, NC 28273-4056
(980) 228-6653
Mailing address
2070 AYRSLEY TOWN BLVD UNIT A, CHARLOTTE, NC 28273-4056
(980) 228-6653
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
C77340
NC
Other
Enumeration date
05/13/2019
Last updated
05/13/2019
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