Healthcare Provider Details

I. General information

NPI: 1295423341
Provider Name (Legal Business Name): FATIMAH Z WEBB LMBT, CAMTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATIMAH Z WEBB LMBT, CAMTC

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 HARRIS AVE
RAEFORD NC
28376-3114
US

IV. Provider business mailing address

512 HARRIS AVE
RAEFORD NC
28376-3114
US

V. Phone/Fax

Practice location:
  • Phone: 910-813-3031
  • Fax:
Mailing address:
  • Phone: 910-813-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23115
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-27753
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: