Healthcare Provider Details

I. General information

NPI: 1184974503
Provider Name (Legal Business Name): YOLANDA JANE OUTLAW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC009376
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: