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General NPI Number Information
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NPI Number | 1538806872
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Entity Type | Organization
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Legal Business Name | FULL CIRCLE WELLNESS AND PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 601 QUAIL VALLEY DR # 327
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City | GEORGETOWN
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State | TX
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Zip | 78626-8051
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Country | US
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Telephone | 541-727-8542
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Fax |
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Provider Business Mailing Address
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Address Line | 102 W 3RD ST STE 1000
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City | WINSTON SALEM
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State | NC
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Zip | 27101-3996
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KERRIE ROUSE
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Credential | PHD, LPC, LMFT
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Telephone | 541-727-8542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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