Provider Demographics
NPI:1184722761
Name:RICE, DALE M (MA)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:M
Last Name:RICE
Suffix:
Gender:M
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 11210
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1210
Mailing Address - Country:US
Mailing Address - Phone:304-346-9586
Mailing Address - Fax:304-344-2169
Practice Address - Street 1:1021 QUARRIER ST
Practice Address - Street 2:SUITE 515
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2338
Practice Address - Country:US
Practice Address - Phone:304-346-9586
Practice Address - Fax:304-344-2169
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV566103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005412001Medicaid
WV0005412000Medicaid
WV0005412003Medicaid
WV0163911000Medicaid
WV0005412000Medicaid