Provider Demographics
NPI:1861848665
Name:ROUSE, MELINDA JANE QUEEN (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:JANE QUEEN
Last Name:ROUSE
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508A VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-9640
Mailing Address - Country:US
Mailing Address - Phone:919-593-5030
Mailing Address - Fax:
Practice Address - Street 1:508A VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-9640
Practice Address - Country:US
Practice Address - Phone:919-593-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3569101YP2500X
VA0701001396101YP2500X
VA0717000381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist