Provider Demographics
NPI:1417420183
Name:RICE, AUDREY A
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:A
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E CHICKASAW RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3906
Mailing Address - Country:US
Mailing Address - Phone:757-450-8507
Mailing Address - Fax:
Practice Address - Street 1:215 E CHICKASAW RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3906
Practice Address - Country:US
Practice Address - Phone:757-450-8507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-06
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000414103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARBT-18-59657OtherRBT
BACB438846OtherBCBA