Individual
LATASHA MONIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMBT
Contact information
Practice address
78 CHURCH ST NE, CONCORD, NC 28025-4757
(980) 219-1809
Mailing address
1270 PINE RIDGE RD, CHINA GROVE, NC 28023-8601
(980) 219-1809
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11988
NC
Other
Enumeration date
06/13/2021
Last updated
06/13/2021
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