Provider Demographics
NPI:1154553824
Name:RICE, TIMOTHY SCOTT (LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:RICE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GOSS ST
Mailing Address - Street 2:
Mailing Address - City:EPWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30541-2428
Mailing Address - Country:US
Mailing Address - Phone:706-455-7061
Mailing Address - Fax:706-492-1152
Practice Address - Street 1:104 GOSS ST
Practice Address - Street 2:
Practice Address - City:EPWORTH
Practice Address - State:GA
Practice Address - Zip Code:30541-2428
Practice Address - Country:US
Practice Address - Phone:706-455-7061
Practice Address - Fax:706-492-1152
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional