Kimberly Robin Outlaw, LCAS-A

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

20276 Issued in NC

Practice address

3367 Ponderosa Dr
La Grange, NC 28551-8067

Phone

(252) 566-9125

NPI assigned

Nov 21, 2015

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 21, 2015.

{
    "created_epoch": "1448064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448064000000",
    "number": "1821462292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3367 PONDEROSA DR",
            "address_2": "3367 PONDEROSA DRIVE",
            "city": "LA GRANGE",
            "state": "NC",
            "postal_code": "285518067",
            "telephone_number": "252-566-9125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3367 PONDEROSA DR",
            "city": "LA GRANGE",
            "state": "NC",
            "postal_code": "285518067",
            "telephone_number": "252-566-9125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OUTLAW",
        "first_name": "KIMBERLY",
        "middle_name": "ROBIN",
        "name_prefix": "Ms.",
        "credential": "LCAS-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-21",
        "last_updated": "2015-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "20276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Radford May
• Keith Michael McGinnis, RPH
• John Thomas Moore, PA-C
• Nova Ic, Inc.
• Open Door Counseling NC, PLLC
• Paradigm, Inc.
• Atit Sharad Patel, MD
• Savannah Phelps, RN
• Precision Training, Inc.
• Premium Healthcare Services

• All providers in La Grange, NC
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.