Provider Demographics
NPI:1225350416
Name:RICE, LESHAE M (MS)
Entity Type:Individual
Prefix:MS
First Name:LESHAE
Middle Name:M
Last Name:RICE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LESHAE
Other - Middle Name:M
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LPC-A LADC
Mailing Address - Street 1:84 LINES PL
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6409
Mailing Address - Country:US
Mailing Address - Phone:203-526-1959
Mailing Address - Fax:
Practice Address - Street 1:84 LINES PL
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-6409
Practice Address - Country:US
Practice Address - Phone:203-526-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6104101YP2500X
CT001028101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1225350416Medicaid