Provider Demographics
NPI:1801310792
Name:RICE, NIKU SHARAFEDDIN (LMSW)
Entity type:Individual
Prefix:
First Name:NIKU
Middle Name:SHARAFEDDIN
Last Name:RICE
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:NIKU
Other - Middle Name:
Other - Last Name:SHARAFEDDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6712 MARK CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-2829
Mailing Address - Country:US
Mailing Address - Phone:916-216-0861
Mailing Address - Fax:
Practice Address - Street 1:17251 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2126
Practice Address - Country:US
Practice Address - Phone:248-916-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2025-03-11
Deactivation Date:2022-06-03
Deactivation Code:
Reactivation Date:2022-07-06
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 374J00000X
MI68511152141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula