MEDICARE: MARY OUTLAW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-26-88211	SC

General Provider Information

NPI Number	:	1588396030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY OUTLAW

Provider Business Mailing Address
First Line	:	209 7TH ST FL 3
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1486
Country	:	US
Telephone Number	:	706-842-5330
Fax Number	:	706-842-5340

Provider Business Practice Location Address
First Line	:	9361 TWO NOTCH RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6430
Country	:	US
Telephone Number	:	706-842-5330
Fax Number	:	706-842-5340

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2022
Last Update Date	:	03/10/2026

Similar Medicare Providers

1144067950 — TIMYA JALISA MASSEY
Practice Location Address:

9361 TWO NOTCH RD
COLUMBIA, SC
29223-6430

Practice Phone: 706-842-5330
Practice Fax: 706-842-5340

1255441168 — CAROLYN WOMACK
Practice Location Address:

1223 1/2 TROTWOOD AVE , STE 100
COLUMBIA, TN
38401-6430

Practice Phone: 391-381-9940
Practice Fax:

1891250361 — SOARING STARS THERAPY & LEARNING CENTER INC
Practice Location Address:

6430 DOBBIN RD STE B
COLUMBIA, MD
21045-4899

Practice Phone: 301-968-0597
Practice Fax: 301-968-0598

1972330066 — LOVING ARMS COMMUNITY SERVICES INC.
Practice Location Address:

6430 DOBBIN RD STE B
COLUMBIA, MD
21045-4899

Practice Phone: 240-646-6863
Practice Fax:

1043172166 — ABIGAIL MAE LUST LCSW
Practice Location Address:

115 ATRIUM WAY STE 221
COLUMBIA, SC
29223-6383

Practice Phone: 803-699-8887
Practice Fax:

1144175043 — SHAYLA KING RBT
Practice Location Address:

200 SPRINGTREE DR STE 100
COLUMBIA, SC
29223-8614

Practice Phone: 803-335-0718
Practice Fax:

Directions to “ MARY OUTLAW ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.