Provider Demographics
NPI:1326448366
Name:ROUSE, KIMBERLY (LISW-S)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:CASTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:8680 ROCK RIFFLE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9656
Mailing Address - Country:US
Mailing Address - Phone:740-292-2010
Mailing Address - Fax:
Practice Address - Street 1:8680 ROCK RIFFLE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9656
Practice Address - Country:US
Practice Address - Phone:740-292-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.14508751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical