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General NPI Number Information
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NPI Number | 1790167690
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Entity Type | Individual
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Provider Name | WANDA LARRIE NAYEEMA ARCHIE-RAHEEM CMT
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Gender | Female
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 429 PERSON ST STE 1-A
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5737
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Country | US
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Telephone | 803-873-7388
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Fax | 888-965-9470
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Provider Business Mailing Address
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Address Line | 2146 HERITAGE WAY
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City | CAMERON
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State | NC
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Zip | 28326-6014
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Country | US
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Telephone | 803-873-7388
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Fax | 888-965-9470
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 17329
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License Number State | NC
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