Provider Demographics
NPI:1760824593
Name:RICE, EUTASHIA (MA)
Entity Type:Individual
Prefix:
First Name:EUTASHIA
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:MA
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 571097
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1097
Mailing Address - Country:US
Mailing Address - Phone:336-716-0800
Mailing Address - Fax:336-716-0822
Practice Address - Street 1:412 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2118
Practice Address - Country:US
Practice Address - Phone:336-751-2041
Practice Address - Fax:336-716-0822
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A10063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional