Individual
STEPHANE LEA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CCT
Contact information
Practice address
1770 OLD SPRING HOUSE LN STE 114, ATLANTA, GA 30338-6213
(770) 806-9048
Mailing address
1770 OLD SPRING HOUSE LN STE 114, ATLANTA, GA 30338-6213
(770) 806-9048
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT007289
GA
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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