Individual
EBONY JADE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
245 KINGSBURY DR, SUMTER, SC 29150-7547
(803) 406-3001
Mailing address
245 KINGSBURY DR, SUMTER, SC 29150-7547
(803) 406-3001
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10030
SC
Other
Enumeration date
05/28/2024
Last updated
05/28/2024
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