=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811806342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES ROUSSEAU LCSWA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2026
-----------------------------------------------------
Last Update Date | 09/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 EASTOWNE DR STE 220
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27514-6224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-408-3212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 MULBERRY ST APT C
-----------------------------------------------------
City | CARRBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27510-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-615-2046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | P024220
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------