Provider Demographics
NPI:1194966283
Name:ROUSE, JANE (RN, MS, CRC, LPC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:RN, MS, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 NATIONAL DR
Mailing Address - Street 2:STE 123
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4066
Mailing Address - Country:US
Mailing Address - Phone:919-781-3149
Mailing Address - Fax:919-781-8593
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:STE 123
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-781-3149
Practice Address - Fax:919-781-8593
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC647OtherLPC