Provider Demographics
NPI:1609909704
Name:RICE, LESLIE R (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:RICE
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 1:209F HENSLEE DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2089
Mailing Address - Country:US
Mailing Address - Phone:615-441-9992
Mailing Address - Fax:615-441-0026
Practice Address - Street 1:209F HENSLEE DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2089
Practice Address - Country:US
Practice Address - Phone:615-441-9992
Practice Address - Fax:615-441-0026
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4040995OtherBLUE CROSS BLUE SHIELD
TN463851OtherVALUOPTIONS
TN3025258Medicare ID - Type Unspecified