Provider Demographics
NPI:1396491429
Name:CAPITOL BEAUTY AND BARBERING LLC
Entity type:Organization
Organization Name:CAPITOL BEAUTY AND BARBERING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:W
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-239-1020
Mailing Address - Street 1:3584 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-5123
Mailing Address - Country:US
Mailing Address - Phone:901-239-1020
Mailing Address - Fax:
Practice Address - Street 1:3584 FORREST AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-5123
Practice Address - Country:US
Practice Address - Phone:901-239-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center