Provider Demographics
NPI:1760175608
Name:BAH, ANITA OUTLAW
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:OUTLAW
Last Name:BAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8398 SIX FORKS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3059
Mailing Address - Country:US
Mailing Address - Phone:919-931-0562
Mailing Address - Fax:
Practice Address - Street 1:8398 SIX FORKS RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3059
Practice Address - Country:US
Practice Address - Phone:919-931-0562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health