| Doctor Name: | MISS MATRICE SHARNAN ROUSE |
| NPI Number: | 1679690572 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1507 |
| Business Practice Address: | 200 Claude Bundrick Rd Blythewood, SC - 290169420 |
| Business Phone Number: | 8037545478 |
| Business Fax Number: | |
| Mailing Address: | 111 Elders Pond Cir Apt 13c, COLUMBIA |
| State: | SC |
| Postal Code: | 292298164 |
| Phone Number: | 8035130821 |
| Fax Number: | |
| NPI Enumeration Date: | 03/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 1507 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |