Provider Demographics
NPI:1396000832
Name:RICE, WANDA J (EDS, MBA)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:J
Last Name:RICE
Suffix:
Gender:F
Credentials:EDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HUNTERS TRAIL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2525
Mailing Address - Country:US
Mailing Address - Phone:615-715-4947
Mailing Address - Fax:
Practice Address - Street 1:130 HUNTERS TRAIL
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2525
Practice Address - Country:US
Practice Address - Phone:615-715-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000566888103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool