Provider Demographics
NPI:1538297502
Name:RICE-JACKSON, LORI J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:J
Last Name:RICE-JACKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:RICE-JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:23 PARKHURST ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6855
Mailing Address - Country:US
Mailing Address - Phone:530-828-5332
Mailing Address - Fax:530-345-3779
Practice Address - Street 1:468 MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1358
Practice Address - Country:US
Practice Address - Phone:530-828-5332
Practice Address - Fax:530-345-3779
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18165104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker