Individual
MARY OUTLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9361 TWO NOTCH RD, COLUMBIA, SC 29223-6430
(706) 842-5330
(706) 842-5340
Mailing address
209 7TH ST FL 3, AUGUSTA, GA 30901-1486
(706) 842-5330
(706) 842-5340
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-26-88211
SC
106S00000X
Behavior Technician
Primary
RBT-22-221906
SC
Other
Enumeration date
06/24/2022
Last updated
03/10/2026
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