Provider Demographics
NPI:1598204620
Name:RICE, MIESHA (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:MIESHA
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 BEDFORD AVE UNIT 32405
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21282-7550
Mailing Address - Country:US
Mailing Address - Phone:443-979-3295
Mailing Address - Fax:410-559-6510
Practice Address - Street 1:104 CHURCH LN # 120
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3786
Practice Address - Country:US
Practice Address - Phone:410-413-6043
Practice Address - Fax:410-559-6510
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1041C0700X
MD195311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1174094593OtherNPPES NPI 2
MD1598204620OtherNPPES NPI 1
MD19531OtherBSWE CLINICAL SOCIAL WORK LICENSE
MD654086400Medicaid