Provider Demographics
NPI:1427610997
Name:ROUSE, TIANA JHANAI (APC)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:JHANAI
Last Name:ROUSE
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 PRESTON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8979
Mailing Address - Country:US
Mailing Address - Phone:706-714-0104
Mailing Address - Fax:706-714-0104
Practice Address - Street 1:633 PRESTON CREEK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8979
Practice Address - Country:US
Practice Address - Phone:706-714-0104
Practice Address - Fax:706-714-0104
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC01575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional