Provider Demographics
NPI:1295423341
Name:WEBB, FATIMAH Z (LCAS,MS ABA)
Entity type:Individual
Prefix:
First Name:FATIMAH
Middle Name:Z
Last Name:WEBB
Suffix:
Gender:F
Credentials:LCAS,MS ABA
Other - Prefix:
Other - First Name:FATIMAH
Other - Middle Name:Z
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8712 TIN LIZZA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-8452
Mailing Address - Country:US
Mailing Address - Phone:910-682-7354
Mailing Address - Fax:
Practice Address - Street 1:5948 FISHER RD STE 202
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5751
Practice Address - Country:US
Practice Address - Phone:980-549-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCLCAS-27753101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician