Provider Demographics
NPI:1861713208
Name:LEBBIE, KUMBA
Entity type:Individual
Prefix:
First Name:KUMBA
Middle Name:
Last Name:LEBBIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 WARMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5359
Mailing Address - Country:US
Mailing Address - Phone:614-367-6037
Mailing Address - Fax:
Practice Address - Street 1:1608 PENWORTH DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5213
Practice Address - Country:US
Practice Address - Phone:614-772-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator