Organization
LTL TRICHOLOGY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTILLA LYNN HAIRSTON (OWNER AN SERVICER)
(276) 340-1044
Entity
Organization
Contact information
Practice address
32 W MAIN ST, MARTINSVILLE, VA 24112-2722
(276) 340-1044
Mailing address
32 W MAIN ST, MARTINSVILLE, VA 24112-2722
(276) 340-1044
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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