Provider Demographics
NPI:1740937200
Name:RICE, LETISHA JOYCE (LADC)
Entity type:Individual
Prefix:
First Name:LETISHA
Middle Name:JOYCE
Last Name:RICE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 GRAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2749
Mailing Address - Country:US
Mailing Address - Phone:218-940-0043
Mailing Address - Fax:
Practice Address - Street 1:4615 GRAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2749
Practice Address - Country:US
Practice Address - Phone:218-207-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305594101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)