Individual
MS. KIMBERLY ROBIN OUTLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS-A
Contact information
Practice address
3367 PONDEROSA DR, LA GRANGE, NC 28551-8067
(252) 566-9125
Mailing address
3367 PONDEROSA DR, 3367 PONDEROSA DRIVE, LA GRANGE, NC 28551-8067
(252) 566-9125
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20276
NC
Other
Enumeration date
11/21/2015
Last updated
11/21/2015
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