Basic Information
| Provider Information | |||||||||
| NPI: | 1720680036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | CARI | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3298 VETERANS DR | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496844725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317158466 | ||||||||
| FaxNumber: | 2319432263 | ||||||||
| Practice Location | |||||||||
| Address1: | 3298 VETERANS DR | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496844725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317158466 | ||||||||
| FaxNumber: | 2319432263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2020 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801108411 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 6801108411 | 01 | MI | LARA MI LICENSE NUMBER | OTHER |