Provider Demographics
NPI:1629321344
Name:RICE, DESARAE SWILLEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DESARAE
Middle Name:SWILLEY
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:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-1111
Mailing Address - Country:US
Mailing Address - Phone:601-799-9500
Mailing Address - Fax:855-675-8575
Practice Address - Street 1:124 KIRKWOOD ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3866
Practice Address - Country:US
Practice Address - Phone:601-799-9500
Practice Address - Fax:855-675-8575
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC69561041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00802501Medicaid