Provider Demographics
NPI:1790167690
Name:AL-LAHABI, WANDA (CMT)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:AL-LAHABI
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 CANADY POND RD.
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348
Mailing Address - Country:US
Mailing Address - Phone:803-397-8340
Mailing Address - Fax:803-850-0033
Practice Address - Street 1:1030 ST. ANDREWS RD.
Practice Address - Street 2:SUITE B-3
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210
Practice Address - Country:US
Practice Address - Phone:888-500-2810
Practice Address - Fax:803-850-0033
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8500OtherSTATE LABOR AND LICENSING BOARD