Individual
MS. TINA CELESTE OUTLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSW,MSW, LISW-CP
Contact information
Practice address
2919 JEFFORDS RD N, OUTLAW'S VISION QUEST FARM, INC., LAMAR, SC 29069-9494
(843) 857-0298
Mailing address
2919 JEFFORDS RD, LAMAR, SC 29069-9494
(843) 713-6205
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5160
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SW1208
—
SC
Enumeration date
12/22/2006
Last updated
01/18/2023
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