Provider Demographics
NPI:1831625979
Name:RICE, TINA LYNN (LMSW, MSED, CADC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LYNN
Last Name:RICE
Suffix:
Gender:F
Credentials:LMSW, MSED, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1811
Mailing Address - Country:US
Mailing Address - Phone:319-774-2045
Mailing Address - Fax:866-496-4073
Practice Address - Street 1:209 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1811
Practice Address - Country:US
Practice Address - Phone:319-774-2045
Practice Address - Fax:866-496-4073
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17071101YA0400X
IA01330104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)