Provider Demographics
NPI:1932864261
Name:OUTLAW, BRANDON EARL (MSW, LCSWA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:EARL
Last Name:OUTLAW
Suffix:
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 LENDEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7035
Mailing Address - Country:US
Mailing Address - Phone:336-288-9190
Mailing Address - Fax:
Practice Address - Street 1:1821 LENDEW ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7035
Practice Address - Country:US
Practice Address - Phone:336-288-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0170331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical