Individual
IMANI N ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC INTERN
Contact information
Practice address
6406 HIGHWAY 78 STE 108, SACHSE, TX 75048-3276
(469) 584-9675
Mailing address
PO BOX 3291, WICHITA FALLS, TX 76301-0291
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
TX
104100000X
Social Worker
Primary
107100
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000
CASH PAY
TX
Enumeration date
10/11/2019
Last updated
10/28/2022
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