Individual
MRS. ILLEANA ELIZABETH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT/MLD
Contact information
Practice address
6682 VAUGHN RD, FAYETTEVILLE, NC 28304-6009
(910) 885-5396
Mailing address
6682 VAUGHN RD, FAYETTEVILLE, NC 28304-6009
(910) 885-5396
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
17654
NC
Other
Enumeration date
02/05/2026
Last updated
02/05/2026
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