Provider Demographics
NPI:1063202869
Name:RICE, RACHAEL (MED, APC, NCC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:RICE
Suffix:
Gender:
Credentials:MED, APC, NCC
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, APC, NCC
Mailing Address - Street 1:104 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3704
Mailing Address - Country:US
Mailing Address - Phone:334-301-7996
Mailing Address - Fax:
Practice Address - Street 1:104 HARWELL AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3132
Practice Address - Country:US
Practice Address - Phone:706-837-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional