Provider Demographics
NPI:1457404238
Name:RICE, DONNA B (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:B
Last Name:RICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:BAIRD
Other - Last Name:TULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 E SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-4619
Mailing Address - Country:US
Mailing Address - Phone:228-255-1827
Mailing Address - Fax:228-255-1847
Practice Address - Street 1:6859 KILN DELISLE RD # 1
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-9257
Practice Address - Country:US
Practice Address - Phone:228-255-1827
Practice Address - Fax:228-255-1827
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC72621041C0700X
CALCS 198741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09528860Medicaid
MS800004119Medicare PIN