Provider Demographics
NPI:1568665644
Name:BRENDA STARR HAIRSTYLING
Entity Type:Organization
Organization Name:BRENDA STARR HAIRSTYLING
Other - Org Name:BRENDA STARR IMAGE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGROVE-ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-638-7880
Mailing Address - Street 1:3105 WESTERN BRANCH BLVD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5543
Mailing Address - Country:US
Mailing Address - Phone:757-638-7880
Mailing Address - Fax:757-638-7880
Practice Address - Street 1:3105 WESTERN BRANCH BLVD
Practice Address - Street 2:SUITE #8
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5543
Practice Address - Country:US
Practice Address - Phone:757-638-7880
Practice Address - Fax:757-638-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1202017211335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier