Individual
HELEN ROUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA/QP
Contact information
Practice address
1102 DUCHESS LN, HUBERT, NC 28539-3827
(910) 326-7963
Mailing address
PO BOX 1936, SWANSBORO, NC 28584-1936
(910) 326-7963
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3409099
CAP/MR/DD
NC
Enumeration date
02/26/2008
Last updated
10/31/2008
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