Provider Demographics
NPI:1841763935
Name:ROUSE, EBONE' JANE'T (LCAS)
Entity Type:Individual
Prefix:MS
First Name:EBONE'
Middle Name:JANE'T
Last Name:ROUSE
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2735
Mailing Address - Country:US
Mailing Address - Phone:910-642-9008
Mailing Address - Fax:
Practice Address - Street 1:805 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2735
Practice Address - Country:US
Practice Address - Phone:910-642-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21190101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)