Provider Demographics
NPI:1487246815
Name:ROUSE, ANGELA T (CSAC, QMHP-A)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:T
Last Name:ROUSE
Suffix:
Gender:F
Credentials:CSAC, QMHP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EXECUTIVE CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3107
Mailing Address - Country:US
Mailing Address - Phone:540-242-9114
Mailing Address - Fax:
Practice Address - Street 1:240 EXECUTIVE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3107
Practice Address - Country:US
Practice Address - Phone:540-242-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102696101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)