Individual provider Active NPI

Lillian Lashae Outlaw, LCSW

  • Clinical Social Worker
  • Mooresville, NC
National Provider Identifier
1760880959
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C014975 Issued in NC
Practice address
122 Gateway Blvd Ste C
Mooresville, NC 28117-5544
Phone
(704) 360-3637
NPI assigned
Dec 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 8874 CT
Clinical Social Worker 1041C0700X C014975 NC Primary

Addresses

Primary practice location

122 Gateway Blvd Ste C
Mooresville, NC 28117-5544

Mailing address

112 Camforth Dr
Mooresville, NC 28117-6858
Phone (203) 317-3333

Other practice location 1

19900 S Main St Ste 8&9
Cornelius, NC 28031-6512
Phone (704) 892-9490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220627001105 NC Practitioner - Clinical Social Worker 5193069615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Integrative Wellness Solutions PLLCGroup PAC ID 8022341494, 143 clinicians

Practice addresses (Care Compare)

122 Gateway Blvd
Suite C
Mooresville, NC 28117-5544
Phone (704) 360-3637

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8874CTMDProfessional Counselor
C014975NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Integrative Wellness Solutions, PLLC Clinical CurrentSince May 15, 2025 Accepting new patients

Locations

10430 Harris Oak Blvd
Ste L
Charlotte, NC 28269
Phone (704) 317-2930

3625 N Elm St
Ste 130
Greensboro, NC 27455

122 Gateway Blvd
Ste C
Mooresville, NC 28117
Phone (980) 766-1030

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1419033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1760880959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 CAMFORTH DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281176858",
            "telephone_number": "203-317-3333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 GATEWAY BLVD STE C",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175544",
            "telephone_number": "704-360-3637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19900 S Main St Ste 8&9",
            "address_purpose": "LOCATION",
            "city": "Cornelius",
            "state": "NC",
            "postal_code": "280316512",
            "country_code": "US",
            "telephone_number": "704-892-9490",
            "fax_number": "704-892-9433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OUTLAW",
        "first_name": "LILLIAN",
        "middle_name": "LASHAE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-20",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "8874",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C014975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

Verify at the official NPI Registry.