Provider Demographics
NPI:1326655051
Name:GRICE, TINA SIMON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:SIMON
Last Name:GRICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 AIRLINE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-4703
Mailing Address - Country:US
Mailing Address - Phone:504-616-4511
Mailing Address - Fax:
Practice Address - Street 1:2820 ATHANIA PKWY STE 1
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5981
Practice Address - Country:US
Practice Address - Phone:504-616-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical