Provider Demographics
NPI:1780129734
Name:ROUSE, FELICIA GRAHAM
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:GRAHAM
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 1:3344 SW 51ST TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9484
Mailing Address - Country:US
Mailing Address - Phone:352-299-1961
Mailing Address - Fax:
Practice Address - Street 1:3344 SW 51ST TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-9484
Practice Address - Country:US
Practice Address - Phone:352-299-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19650405300000X
FL813587742405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional