Healthcare Provider Details

I. General information

NPI: 1881569697
Provider Name (Legal Business Name): FULL CIRCLE WELLNESS AND PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 3RD ST STE 1000
WINSTON SALEM NC
27101-3996
US

IV. Provider business mailing address

102 W 3RD ST STE 1000
WINSTON SALEM NC
27101-3996
US

V. Phone/Fax

Practice location:
  • Phone: 512-355-1091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KERRIE ROUSE
Title or Position: OWNER
Credential: PHD, LCMHCA, LMFT
Phone: 512-355-9091