Provider Demographics
NPI:1710223714
Name:ROUSE, LENORA CAMPBELL
Entity Type:Individual
Prefix:
First Name:LENORA
Middle Name:CAMPBELL
Last Name:ROUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 SLATER AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3574
Mailing Address - Country:US
Mailing Address - Phone:910-551-6607
Mailing Address - Fax:
Practice Address - Street 1:5809 DEPARTURE DR STE 106
Practice Address - Street 2:YELVERTON ENRICHMENT SERVICES, INC.
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1936
Practice Address - Country:US
Practice Address - Phone:919-872-6220
Practice Address - Fax:919-872-6223
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NCP0095951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)