Provider Demographics
NPI:1902519721
Name:I AM DREA
Entity Type:Organization
Organization Name:I AM DREA
Other - Org Name:I AM DREA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASTER COSMOTOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ONYX & MANE
Authorized Official - Middle Name:CUSTOMS
Authorized Official - Last Name:LLC
Authorized Official - Suffix:
Authorized Official - Credentials:SPECIALIST
Authorized Official - Phone:954-305-4061
Mailing Address - Street 1:2852 DEANS BRIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2767
Mailing Address - Country:US
Mailing Address - Phone:954-305-4061
Mailing Address - Fax:
Practice Address - Street 1:111 NORTHMAN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4110
Practice Address - Country:US
Practice Address - Phone:954-305-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONYX & MANE CUSTOMS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-27
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty