Provider Demographics
NPI:1356412191
Name:RICE, MARLYNA E (LCSW LICENSED CLINIC)
Entity type:Individual
Prefix:
First Name:MARLYNA
Middle Name:E
Last Name:RICE
Suffix:
Gender:F
Credentials:LCSW LICENSED CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8134 COUNTRY VILLAGE DRIVE
Mailing Address - Street 2:#102
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016
Mailing Address - Country:US
Mailing Address - Phone:901-756-8398
Mailing Address - Fax:901-757-8701
Practice Address - Street 1:8134 COUNTRY VILLAGE DRIVE
Practice Address - Street 2:#102
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016
Practice Address - Country:US
Practice Address - Phone:901-756-8398
Practice Address - Fax:901-757-8701
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000893104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3692114Medicare ID - Type Unspecified
3692115Medicare ID - Type Unspecified