Provider Demographics
NPI:1598377731
Name:LUX GLAMOROUS WIGS & COMPANY
Entity Type:Organization
Organization Name:LUX GLAMOROUS WIGS & COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-437-2272
Mailing Address - Street 1:308 UNIONVILLE INDIAN TRAIL RD W STE C
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5551
Mailing Address - Country:US
Mailing Address - Phone:757-289-2020
Mailing Address - Fax:
Practice Address - Street 1:308 UNIONVILLE INDIAN TRAIL RD W STE C
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5551
Practice Address - Country:US
Practice Address - Phone:757-289-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63644OtherCOSMETOLOGY LICENSE