Individual
JOVHANNAH TISDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMBT
Contact information
Practice address
1788 HERITAGE CENTER DR STE 202, WAKE FOREST, NC 27587-3972
(919) 656-1088
Mailing address
1788 HERITAGE CENTER DR STE 202, WAKE FOREST, NC 27587-3972
(919) 656-1088
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20691
NC
Other
Enumeration date
08/03/2023
Last updated
04/20/2024
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