Provider Demographics
NPI:1740501923
Name:OUTLEY, DELTA JOYCE (MASTERS)
Entity type:Individual
Prefix:MS
First Name:DELTA
Middle Name:JOYCE
Last Name:OUTLEY
Suffix:
Gender:F
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5206
Mailing Address - Country:US
Mailing Address - Phone:706-442-3963
Mailing Address - Fax:706-561-3578
Practice Address - Street 1:7000 STORAGE CT
Practice Address - Street 2:SUITE 10
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-0700
Practice Address - Country:US
Practice Address - Phone:706-593-8031
Practice Address - Fax:706-561-3578
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005750101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor