Provider Demographics
NPI:1871820134
Name:OUTLAW, AMANDA CLARICE (LPC, LCAS-P)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:CLARICE
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:LPC, LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 OLD HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-6854
Mailing Address - Country:US
Mailing Address - Phone:252-527-0669
Mailing Address - Fax:
Practice Address - Street 1:855 OLD HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-6854
Practice Address - Country:US
Practice Address - Phone:252-527-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional