Individual
JENNIFER OUTLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C, LCSW, LISW-C
Contact information
Practice address
846 ERIKA LN, GROVETOWN, GA 30813-8302
(757) 537-9607
Mailing address
846 ERIKA LN, GROVETOWN, GA 30813-8302
(757) 537-9607
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
14065
SC
1041C0700X
Clinical Social Worker
Primary
26026
MD
1041C0700X
Clinical Social Worker
CSW007251
GA
Other
Enumeration date
02/26/2015
Last updated
10/16/2021
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